Cardiac tamponade caused by migration of a swallowed sewing needle

The case of a 20-year-old female prisoner who died due to cardiac tamponade caused by a swallowed sewing needle migration is reported. According to the autopsy report and complete analysis of medical records, the migration of the swallowed needle was reconstructed: from esophagus and stomach, through diaphragm and pericardium up to the left heart ventricle, where the needle was found at the autopsy. The case is very interesting and unique: there has been no similar case described in medical literature so far.     

Amount of postmortem bleeding: an experimental autopsy study

An experimental autopsy study was performed on 64 cases (55 male, 9 female; average age 51.5 +/- 16.2 years) of sudden natural (38 cases) and asphyxic deaths (26 cases). The study objective was the amount of postmortem bleeding from postmortem cutting of the thoracic aorta, related to the time since death. The amount of postmortem bleeding ranged from 100 to 1300 cm, 440.6 +/- 268.1 cm on average. The time since death up to the autopsy time ranged from 4 to 72 hours, 19.4 +/- 12.9 in average. A statistically significant correlation between the amount of postmortem bleeding and postmortem time interval was stated: Pearson correlation test value r = -0.461 (P = 0.000): the shorter the time interval, the larger the amount of bleeding. The formula of linear regression was estimated according to this correlation: amount of postmortem bleeding (cm) = -9.571 x time since death (h) + 626.659. This proves that the amount of postmortem bleeding (eg, from aortic blunt rupture) could be about 620 cm.     

Medicolegal diagnostic value and clinical significance of traumatic incomplete tears of the basilar artery

Ruptures of arteries of the vertebrobasilary system are relatively frequent in medicolegal practice, and their origin may be both natural and violent. Tears that affects the whole thickness of the basilar artery cause subarachnoid hemorrhage (SAH), with an often rapid fatal outcome. 1-3 However, in some situations, arterial tears may be incomplete, involving the intima or both the intima and the media, but with preserved adventitia. 1, 4 Although such incomplete tears are not the source of immediate subarachnoid bleeding, their presence may be important from both a medicolegal and a clinical point of view.The aim of this article is to point out the significance of incomplete tears of basilar artery as a possible diagnostic sign of traumatic origin of SAH as well as a certain mechanism of injury, which involves forcible hyperextension and rotational movements of the head. The authors also describe their method of performing longitudinal section of the basilar artery, both at autopsy and for histologic examination, which is convenient for identifying multiple transversal incomplete tears of this blood vessel. The article is based on the analysis of three cases from the autopsy material of the Institute of Forensic Medicine in Belgrade.     

Mechanisms of aortic blunt rupture in fatally injured front-seat passengers in frontal car collisions: an autopsy study

We tried to explain the mechanisms of the aortic blunt ruptures in fatally injured drivers and front passengers, unrestrained by seatbelts, by analyzing the frequencies of both aortic ruptures and concomitant injuries to 12 organs and body regions. The sample consisted of 393 subjects: 251 drivers and 142 front passengers (325 male and 68 female passengers, the mean age 41.0 +/- 15.5). The total number of the complete blunt aortic ruptures in the sample was 116 (80 in the drivers and 36 in the front passengers). The weakest part of the aorta seems to be the isthmus (47 isthmus ruptures in the drivers and 27 in the front passengers). The statistically significant concomitant injured organs and body regions with the aortic ruptures were the liver, the sternum, and the diaphragm in the car drivers and the head and the neck in the front passengers. According to these results, the mechanisms of thoracic aorta rupture are different for fatally injured drivers and front passengers. For car drivers, they are associated and simultaneous with both thoracic and abdominal compression due to deceleration of the body at the moment when the driver's body slides forward and flexes across and against the steering wheel. For the front passengers, the mechanism is the caudorostral hyperextension of the thoracic aorta at the moment when the body is stopped by a dashboard, but the head continues forward with great velocity: the carotid vessels pull the aortic arch forward at the same time as the intercostal arteries fix the thoracic part of the aorta and pull it downwards.     

Anomalous Anterior Papillary Muscle as an Autopsy Finding in Two Cases

Anomaly in the anterior papillary muscle (APM) is known to cause left ventricle outflow tract (LVOT) obstruction, and this rare congenital condition could be a cause of sudden cardiac death. This anomaly and its hemodynamic effects is similar to valvular heart disease. In our two described cases, in which cause of death was, respectively, hypertrophic cardiomyopathy and suicide by hanging, the cephalad portion of the left APM was inserted directly into the ventricular surface of the anterior mitral leaflet and chordae tendineae were absent in the area of the direct anomalous muscle insertion; the aberrant papillary muscle was very large and showed an exaggerated anterior displacement within the left ventricular cavity. The described anomaly is a cause of LVOT obstruction. This condition is considered to be rare, although incidence estimates do not exist. In the absence of other possible causes, this finding may indicate arrhythmia as being the immediate cause of death.     

Laryngeal Choking on Food and Acute Ethanol Intoxication in Adults—An Autopsy Study*

Abstract: The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (χ² = 6.843, p < 0.01), average age 58.61 ± 15.87 years (range 26–92 years). Most of the subjects had poor dentition (χ² = 34.327, p < 0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3 g/dL (SD = 11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (χ² = 38.874, p < 0.01), and at the same time significantly more intoxicated (z = −7.126, p < 0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death.