Sudden Death Due to Infiltration of Left Bundle Branches by Interventricular Septal Cardiac Fibroma

Cardiac fibromas are benign conditions; however, their location and size may cause ventricular arrhythmias and sudden cardiac death. We report a case of a 68‐year‐old female who died suddenly. Postmortem investigation detected a huge cardiac fibroma in the pars muscularis of the interventricular septum, occupying almost the entire muscular septum, and restricting the volume of left ventricular chamber. Histological examination revealed numerous foci of calcification in the alternating complex interlacing or strictly parallel collagenous fiber mass. Tumor mass was mainly demarcated, but in some places, fibrous infiltration of surrounding working cardiac muscle was found. We present a case when direct tumor involvement in the descending left bundle branches was evidenced. Mainly, the branches of septal fascicle were disrupted, entrapped, and degenerated by the tumor mass. This case report emphasizes that postmortem histological examination of conduction system in all sudden cardiac death cases may substantially improve the accuracy of postmortem diagnosis.     

云南省44例主动脉夹层破裂死亡法医学分析

目的对云南省44例主动脉夹层破裂死亡的案例进行回顾性分析,为此类案件的法医学鉴定提供一定参考。方法收集2002~2017年昆明医科大学司法鉴定中心受理的44例主动脉夹层破裂死亡案例,对其一般情况、临床分期、临床表现、危险因素、病理分型、内外膜破裂情况、直接死因等进行统计分析。结果主动脉夹层高发于在40~49岁,男性多于女性,大多数为急性主动脉夹层。冬季死亡数最高,春季死亡数最低;疼痛为最常见首发症状,动脉粥样硬化是重要危险因素;A型主动脉夹层占比高于B型主动脉夹层,破口主要发生在升主动脉,其形态多为横行;心脏压塞是主要死因。结论主动脉夹层破裂前多有明确首发症状,可合并多种高危因素,注重与损伤的鉴别以及医疗因素的因果关系判断,对法医学鉴定具有较大意义。     

致死性心脏压塞38例法医病理学分析

目的探讨致死性心脏压塞的法医病理学特点和鉴定要点。方法对成都中医药大学附属医院病理科2005~2015年完成的38例心脏压塞致死案例进行回顾分析。结果致死性心脏压塞好发于男性(71.1%),平均年龄44岁;直接死因血性积液34例,非血性4例;根本死因以疾病多见(73.7%),主要为夹层动脉瘤、冠心病、恶性肿瘤;发病12小时内死亡占75%;涉及医疗行为30例(78.9%),26例无医疗过错(86.7%);疾病致死案件涉及伤病关系15例(39.5%)。结论掌握致死性心脏压塞的法医病理学特点和鉴定路径是准确完成该类案件法医学鉴定的基本要求。     

Pericardial Cyst: Cause of Sudden Cardiac Death?

Cardiovascular disease is the leading cause of sudden death in the world. The etiology of sudden cardiac death involves a wide range of diseases, but seldom pericardial cysts. A pericardial cyst is an uncommon cyst usually located in the middle mediastinum and rarely in the posterior part. They are usually harmless and asymptomatic. Here, we present a case of a 63‐year‐old woman who presented with dyspnea and hoarseness, but died suddenly after a CT scan was attempted. The detailed forensic pathologic and histologic examination revealed a pericardial cyst located in the posterior mediastinum. Toxicology and biochemistry tests, including tryptase, found no competing cause of death.     

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals

Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78‐year‐old woman, found dead in a small forest with broad‐leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.     

肢体挤压伤大鼠早期心电图及血清cTnI的变化

目的观察挤压伤大鼠早期心电图的改变,并检测血清心肌肌钙蛋白I(cTnI)的变化。方法复制挤压伤大鼠动物模型,标准Ⅱ导联记录心电图变化,化学发光法检测血清cTnI水平。结果挤压伤后心电图ST段明显抬高,并持续24h,伤后6h血清cTnI则显著升高,并持续24h以上。结论肢体挤压伤早期存在心肌细胞的损伤。     

阴性解剖中的心脏性猝死

综述了近年来有关心脏性猝死的分子生物学和电生理学的研究进展,着重讨论了心震荡、先天性长QT间期综合征和Brugada综合征,可能诱发致死性心律失常,发生心脏性猝死。这些功能性病症死亡常可导致病理解剖时无明显客观器质性病理改变。提示法医和病理工作者在遇到阴性解剖猝死时,应注意了解猝死的诱因、继往病史和家族病史,注意排除可能存在的这些病症。     

儿茶酚胺致心肌损伤的实验病理研究

大鼠尾静脉滴去甲肾上腺素（20μg／kg／min）后，分别于即刻、7天、30～90天杀死取材，用病理组织学、肌红蛋白免疫组化染色及透射电镜观察心肌损伤。结果：早期可见心肌多灶性坏死、肌红蛋白缺染、肌原纤维断裂溶解，似冠状动脉无阻塞性心肌梗死；中后期可见心肌灶性萎缩及疤痕形成、成纤维细胞增生活跃、新生胶元原纤维伸入坏死心肌内，类似早期心肌病图象。     

Myxoid heart disease: A review with special emphasis on sudden cardiac death

Myxoid heart disease (MHD), more commonly known as mitral valve prolapse, is a very common caridac abnormality affecting 5–10% of the general population. This article reviews the history, symptoms, physical findings, pathology, associated conditions and complications of this entity. Special emphasis is given to sudden cardiac death, which occurs as a result of acute heart failure or due to a fatal arrhythmia. Theories regarding the origin of the arrhythmias are discussed. Once the origin is known, those at risk for this devastating complication can be identified and perhaps a preventative therapeutic regimen developed.     

Delayed fatal impact cardiopathy

The lesions of impact cardiopathy ("cardiac contusion") which fail to heal satisfactorily, leading to delayed heart failure and death, are infrequently recognized, in part because of a general lack of appreciation of the lingering significance of lesser degrees of trauma. The case of a 31-year-old male dying 4 weeks after a vehicular collision provides strong confirmation of the expectable intermediate aspects of this spectrum of post traumatic lesions.