Autopsy: failed intubation – what was the cause?

Abstract

Aim and Methods A 77-year-old man presented to the Emergency Department with profound shortness of breath. The intubation failed due to upper airway obstruction and subsequently he underwent cri-cothyroidotomy. He had a cardiac arrest for up to 20 minutes in the Emergency Department. He was transferred to the Intensive Care Unit. He showed evidence of global ischaemia of the brain and his life support equipment was stopped after 3 days. His past medical history included beta thalassaemia and C3 to C7 laminectomy for severe cervical myelopathy 4 months prior to his death. Results The autopsy revealed a polypoid laryngeal tumour 3.2 cm in maximum dimension arising from the right vocal cord. The tumour extended to the glottic and supraglottic spaces. The superior aspect of the tumour was visible behind the epiglottis. Histologically, the tumour was a carcinosarcoma with squamous cell carcinoma and osteosarcoma component with sarcomatous component overgrowth. Discussion Carcinosarcoma of the larynx is a very rare tumour predominantly occurring in elderly males. They are rapidly growing polypoid tumours which often present with acute airway obstruction. In this case, the retrospective review of the MRI performed 4 months ago for the cervical laminectomy showed a 0.7 cm nodule on the vocal cord.