Death of a pentagenarion due to a cardiac tumor; a case report

Abstract

<strong>Introduction</strong> Sudden deaths are usually referred for autopsy. Most of them turn out to be having natural causes. When the cause is an uncommon pathology, inexperienced or unsuspecting practitioners could miss it. Even after identifying such pathology, working out the mechanism of death also can be difficult. This was one such less common case where a primary cardiac tumor was detected. <strong>History</strong> A 55 year old lady found dead in the backyard of her home. The body had been in prone position and wet with sweating. There was no past or family history of any significant illness other than a few fainting attacks which were not attended to. Scene visit investigations revealed a non suspicious death although relatives raised some suspicion regarding the delay in seeking medical assistance. <strong>Postmortem Examination</strong> There was a mobile jelly like pedunculated, irregular shaped growth, 3cm x 2 cm x 2cm in size arising from the inter-atrial septum at the border of the fossa ovalis of the left atrium. When the heart was in the anatomical position, the lump could touch the atrial aspect of the mitral valve obliterating the flow but there was no distortion of valve cusps. Cut sections of the left ventricular wall showed multiple patchy fibrotic areas distributed throughout the ventricular wall. Autopsy examination excluded antemortem violence and other pathologies. Macroscopic and microscopic features were consistent with myxoma of left atrium. <strong>Conclusions</strong> Due to the rarity of the occurrence and the jelly like appearance, an inexperienced or unsuspecting practitioner may miss myxomas mistaking it for a postmortem blood clot. Therefore awareness of this entity is important among forensic practitioners. As they are found in middle age group, other cardiac pathologies such as ischaemic or hypertensive changes as well as valvular changes can coexist. In such cases attributing the death to a myxoma can be difficult unless pathological changes and clinical presentations are analyzed meticulously. <br /> Medico-Legal Journal of Sri Lanka 2013; 1(3) : 14-16