新生儿呼吸系统疾病死亡的法医病理学分析

目的分析和探讨呼吸系统疾病引起新生儿死亡的病理学特点,为法医学死亡原因鉴定和相关医疗纠纷鉴定提供科学依据。方法回顾性总结分析1993～2008年16年间攀枝花市公安局尸检档案中85例新生儿死亡案例。结果呼吸系统疾病是引起新生儿死亡的首要因素（共56例,占65.88%）,其中新生儿吸入性肺炎20例（23.53%）、新生儿感染性肺炎14例（16.47%）、新生儿窒息12例（14.12%）、新生儿肺透明膜病6例（7.59%）、新生儿肺出血4例（4.71%）。结论新生儿尸检应重视呼吸系统的检查,根据新生儿发病特点和肺部病理变化明确临床诊断和死亡原因。     

先天性主动脉-肺动脉间隔缺损1例

主动脉-肺动脉间隔缺损(aortopulmonaryseptalde鄄fect)又称主动脉-肺动脉窗或主-肺动脉瘘,为一种罕见的先天性心脏病。我们遇见1例因新生儿死于该疾病而引发医疗纠纷的案件,报道如下。1案例妊娠足月剖宫产,男性新生儿,体重2600g。出生后,全身轻度紫绀,未闻及心脏杂音、肺湿罗音;四肢活动无力。Apgar评分:1min6分;5min7分。临床诊断:新生儿呼吸窘迫综合征?经救治,症状不见好转。出生后5h,突然呼吸急促,全身紫绀明显,心底部闻及收缩期杂音、肺湿罗音,死亡。尸检所见:死后48h尸检。尸长48cm,发育正常、营养中等,体表未见明显畸形。尸斑暗红色…     

先天性肺动脉狭窄合并动脉导管扩张1例

中心型左右肺动脉狭窄合并动脉导管扩张为一种罕见的先天性心脏病,国内外文献尚未见这种类型先心病发病率统计报道。作者遇到1例新生儿死于该疾病而引发医疗纠纷的案件,报道如下。案例男性新生儿,足月顺产,体重3100g。初生时哭声响亮,自主呼吸,偶有一过性紫绀,心率130次/分,Apgar评分:1min8分,5min10分(依据临床病历资料)。予以吸氧,保温2小时,未见明显异常。后随母返病房约1小时后,面色苍白,鼻腔溢出粉红色液体泡沫,呼吸心跳停止,经抢救无效死亡。临床死亡诊断:先天性心脏疾病?先天性肺发育不良或畸形?颅内出血?先天性代谢疾病?尸检所见:…     

75例新生儿死亡案例法医学回顾分析

目的回顾分析新生儿的性别、存活时间、妊娠和分娩情况、病理检验和死亡原因等方面的问题,以探讨新生儿死亡的法医病理学特点。方法收集中国医科大学法医司法鉴定中心1996年～2016年的75例新生儿尸检案例,内容包括病史资料、妊娠分娩及新生儿出生情况、尸检记录、病理检验和死亡原因等,对性别、妊娠分娩情况、出生时Apgar评分及存活时间等资料进行统计分析。结果脐带绕颈导致的宫内窒息死亡多发生于出生后2h以内,羊水吸入性窒息及肺透明膜病死亡多发生于出生后24h以内,而羊水吸入性肺炎导致的死亡多发于出生后1d～7d。结论对于新生儿死亡原因鉴定,法医学工作者除了在进行系统解剖及常规毒物检查外,还应当充分考虑新生儿出生时一般状况、 Apgar评分等临床资料以及新生儿的存活时间,以对死亡原因作出准确鉴定。     

新生儿肺放线菌病一例报告

放线菌病是由以色列放线菌引起的慢性化脓性炎症‘’‘，国内报道的呼吸系统放线菌病较为少见，现将遇到的一例新生儿肺放线菌病报告如下。案例男婴，出生3天，体重30009。婴儿子生后第二日开始，口吐白沫，日周紫纣；第三日晨起吐血性分泌物，呼吸困难，紫钳，晚9时许死亡，拟诊为先天性心脏病、死后第二天尸体解剖。尸表无异常。扁桃体肿大，挤压见隐窝内有脓液溢出。左肺重48s，右肺52s，双肺表面及切面布满灰白色及黄色病灶，呈米粒至黄豆大小，触之略硬，病灶周围有充血带；镜下见气管及支气管内少量淡红色泡沫状液体。心脏各瓣膜无异…     

肺硅沉着症合并感染死亡1例

1案例资料 1．1简要案情 谭某，男，43岁，自2004年4月起在某煤矿从事井下采煤工作，2008年10月17日因咳嗽、咯血到某县人民医院检查，胸部X片报告：双肺可见大量细小节状阴影，肺纹理增多且紊乱，双肺气肿征象，膈面模糊。2008年11月22日凌晨死于家中。     

针刺肺俞穴致死两例报告

针刺肺俞穴致死两例报告刘晓，赵建清例１某男，５３岁。主因咳嗽、咳痰１５年，加重伴呼吸困难２０天，就诊于某乡医院．查体：桶状胸，呼吸动度减弱，叩鼓音，呼吸音减弱，可闻及散在痰鸣音。余征不著。诊断为慢性阻塞性肺气肿合并感染。给予抗炎、解痉及平喘治疗数日，...     

先天性肺动脉狭窄合并动脉导管扩张1例

中心型左右肺动脉狭窄合并动脉导管扩张为一种罕见的先天性心脏病，国内外文献尚未见这种类型先心病发病率统计报道。作者遇到1例新生儿死于该疾病而引发医疗纠纷的案件，报道如下。     

气管食管瘘致硫酸钡肺内沉积医疗损害鉴定1例

1案例1.1简要案情和病史摘要杜某,男,54岁,食管癌根治术后、化疗后5年余,平素无不适。2014年11月17日因“咳嗽、咽痛、纳差5d”就诊于某县人民医院。查体:生命体征平稳,咽部稍红肿,胸廓术后改变;双肺呼吸音粗糙,可闻及少许干湿啰音。血常规结果显示白细胞计数8.08×10^9/L、中性粒细胞百分比86.51%。肝肾功能、电解质、血糖等未见异常。胸部CT示双肺少许炎症,慢性支气管炎、肺气肿。     

乙酸酐中毒的实验病理研究

利用大白鼠和家兔灌胃及静脉注射乙酸酐引起中毒，并在光镜和电镜下观察动物中毒后的病理变化。结果发现：（1）胃粘膜坏死、溃疡，胃穿孔。（2）肝细胞、肾小管上皮细胞颗粒变性，管腔内出现大量管型，肺灶性出血、肺气肿。实验结果说明；乙酸酐除了能引起消化道馈疡、穿孔外，还可导致肾功能衰竭。     

The use of pulmonary interstitial emphysema as an indicator of live birth

Making the determination of live birth versus stillbirth in a discarded newborn infant based on gross and microscopic autopsy findings can be a challenging task for the forensic pathologist. The traditional criteria for live birth determination are frequently challenged in court, and indisputable evidence of live birth remains elusive. The histologic finding of pulmonary interstitial emphysema has not been considered as a useful determinant of live birth. The authors report two cases of discarded newborn infants in which the finding of pulmonary interstitial emphysema was used as an indicator of live birth.     

Pulmonary interstitial emphysema in live birth determination: radiographic and gross pathologic features

Pulmonary interstitial emphysema (PIE) has previously been reported as a useful finding in the determination of live birth in cases where the birth and death were not attended. Herein, we present the radiographic and gross pathologic features of PIE in such a case. In this instance, in addition to parenchymal interstitial emphysema, there were subpleural air collections and a pneumothorax.     

Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.     

Barotrauma and air embolism in hyperbaric oxygen therapy

A 69-year-old woman underwent hyperbaric oxygen therapy because of a nonhealing ulcer of her foot. During decompression, she developed a left-sided hemiplegia and confusion. Recompression resulted in transient neurologic improvement, but she eventually became comatose. Ventricular dysrhythmias developed and she died without regaining consciousness 17 h after onset of symptoms. An autopsy revealed diffuse interstitial pulmonary fibrosis with severe paracicatricial emphysema, chronic interstitial inflammation, and chronic bronchitis with abundant intrabronchial mucus. There was extensive multifocal ischemic injury of the cerebral cortex. The hippocampi, basal ganglia, and cerebellum were spared. Scattered acute myofiber necrosis was present in the heart. Clinical presentation and autopsy findings strongly support the diagnosis of air embolism and illustrate a potential risk of hyperbaric oxygen therapy in patients with preexisting pulmonary disease.     

Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis

A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. Air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism.     

The significance of pulmonary interstitial emphysema in live birth determination

The utility of pulmonary interstitial emphysema (PIE) in live birth determination is not well established. Because the distinction between live birth and stillbirth may be important in criminal proceedings, we undertook this study to investigate the relationship between the histologic finding of PIE and live birth. Sixty-six cases of infant death were retrieved and compared with 21 stillborn infants. Histologic sections of the lungs were characterized as "florid PIE," "equivocal PIE," or "absent PIE." Sixteen cases of florid PIE were identified, all in live born infants. Forty-seven cases of equivocal PIE were found in 36 live born and 11 stillborn infants. In 24 cases (14 live born infants and 10 stillborns), no PIE was identified. We examined the relationship between florid PIE in infants with sudden infant death syndrome (SIDS) or "sudden unexpected death in infancy, manner undetermined" (SUDI), and also its relationship to other variables. No association was found. The presence of equivocal PIE may be an artifact of tissue processing. Florid PIE is found only in live born infants. No correlation between the presence of florid PIE and cause of death could be determined.     

Pulmogenic air embolism

Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction.     

Cervical soft tissue emphysema in hanging--a prospective autopsy study

The underlying mechanism of cervical soft tissue emphysema (CSTE) in hanging remains unclear. The aim of this study was to determine the frequency of CSTE in cases of hanging. The sample included 83 deceased persons, average age 55.3 ± 17.9 years. CSTE was established in 44 cases. CSTE is presented as frothy air, soap bubble-like formations in superficial and/or deep connective tissue between the neck muscles up to the ligature mark, visible during gross neck examination, using special neck autopsy technique-preparation of the neck organs in layers. The interpretation of positive CSTE must be taken with caution: it could be an antemortem phenomenon possibly because of either Macklin Effect or direct or indirect trauma to the cervical airways, as well as an ante- or postmortem artifact.     

Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases

Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia.     

Forensic medicine and morphologic aspects of fatal amniotic fluid aspiration

The massive aspiration of amniotic fluid as one cause of a fatal postpartal asphyxia will be demonstrated under the aspect of preliminary criminal law proceedings against physicians because of medical negligence. The pathomorphologically established diagnosis of a fatal aspiration of amniotic fluid supposes extensive and systematic quantitative histological examination of both lungs. The technique of histological cross sections through the entire lung combined with morphometry is a suitable method to exactly record the alterations of bronchi and lung parenchyma by aspiration of amniotic fluid and their complications, such as interstitial emphysema.