Autopsy Findings Research Articles

Animal study results of a novel designed transcatheter mitral valve replacement system

Objective: To preliminarily assess the biocompatibility and durability of the TruDeltaTM transcatheter mitral valve replacement (TMVR) system. Method: Six adult sheep were divided into 3 groups based on the duration of follow-up: 30 days (n=1), 90 days (n=3) and 180 days (n=2). The TruDeltaTM TMVR system was implanted through a transapical approach under transesophageal echocardiographic guidance. The operability of the TMVR system was evaluated using an instrument performance evaluation scale (consisting of 39 items), with scores ranging from 1 (worst) to 10 (best) assigned by the operator. Echocardiography was conducted preoperatively, immediately after surgery, and at 30, 90, and 180 days post-implantation. At the last follow-up time point, the intervention mitral valve membrane and major organs were dissected for observation. The artificial valves were taken for hematoxylin eosin (HE) staining and observed under a scanning electron microscope. Result: All six procedures were successfully completed using 29S size TruDeltaTM TMVR device. At the final follow-up, echocardiogram demonstrated good valve function without obvious paravalvular leakage, with a transvalvular gradient of (7.8±3.2) mmHg (1 mmHg=0.133 kPa) and a mitral valve orifice area of (1.8±0.2) cm2. Autopsy findings revealed no structural valve failure and almost complete endothelialization (>75%) with 90 to 180 days. Both HE staining and scanning electron microscopy confirmed optimal endothelialization of the valve stent. Conclusion: The preclinical animal study indicates that the TruDeltaTM device exhibits favorable biocompatibility and durability.

Metastatic gastric adenocarcinoma in a grey seal Halichoerus grypus: clinicopathological and immunohistochemical characterization.

A 33 yr old female grey seal Halichoerus grypus presented with inappetence and progressive weight loss. Medical management included blood analysis, imaging, and fecal evaluation, along with multimodal supportive therapy, which periodically improved the overall medical condition. Six months after the initial presentation, the clinical condition deteriorated significantly, including severe hyporexia, hematemesis, and marked neutrophilic leukocytosis, which led to the decision to euthanise based on welfare grounds. Necropsy findings included severe thickening of the distal esophagus, cardia, and proximal gastric fundus, as well as multiple nodular to cystic structures over the stomach's serosa, omentum, and mesentery. Histologically, a mucinous gastric adenocarcinoma was diagnosed, with metastasis to the gastric lymph nodes and prominent carcinomatosis involving the omentum, mesentery, and diaphragm. Immunohistochemically, the gastric adenocarcinoma was positive for cytokeratin AE1/AE3, weakly positive for COX-2 and E-cadherin, and negative for vimentin. The Ki-67 proliferative index was low (0.8). Although rare, this case offers further insights into the clinical presentation, histopathology, and immunohistochemical profile of gastric tumors in pinnipeds.

Can Fetal Heterotaxy Syndrome Be Diagnosed Through Prenatal Ultrasound in the First Trimester (GA 11+0-13+6Weeks)?

To investigate the value of prenatal ultrasonography in the diagnosis and classification of fetal heterotaxy syndrome (HS) in the first trimester (gestational age 11+0-13+6weeks). A retrospective analysis of data from 31 HS fetuses prenatally diagnosed with HS. Diagnoses were confirmed by follow-up prenatal ultrasound and in some cases postnatal ultrasound or autopsy. Data were collected on ultrasound characteristics of left atrial isomerism (LAI) and right atrial isomerism (RAI) in the first trimester, follow up ultrasounds, pregnancies outcomes, and postnatal ultrasound or autopsy findings, if available. In total, 23cases of HS were diagnosed in the first trimester, and 8 cases were missed during the GA 11+0-13+6weeks ultrasound. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of prenatal ultrasound examination for fetal HS were 74.19%, 100%, 0, 25.80%, 100%, and 99.98%, respectively. The main and common manifestations of fetal HS included abnormal positioning of the stomach and heart and positioning of the stomach and umbilical vein (UV) on different sides, combined with complete atrioventricular septal defect (AVSD), double outlet of the right ventricle (DORV) and other CHDs. Compared with RAI, fetuses with LAI in the first trimester of pregnancy were more prone to bradycardia and ductus venous (DV) a-wave inversion (p<0.05). Among the 31 HS cases, only 6 pregnancies were continued, resulting in one neonatal death and five liveborns with a good prognosis. Ultrasound performed during GA 11+0-13+6weeks can be an effective tool for diagnosing fetal HS, particularly when significant cardiovascular anomalies are present. However, fetal LAI without complex intracardiac malformations is more likely to be missed in diagnosis during the first trimester. Most cases of HS diagnosed in early pregnancy are associated with major intracardiac anomalies and result in termination of pregnancies.

Autopsy results and factors associated with sudden cardiac death in young individuals with congenital heart disease – a nationwide study

Objectives Sudden cardiac death (SCD) is a leading cause of mortality among individuals with congenital heart disease (CHD), and risk stratification remains challenging. This study aimed to describe the underlying structural cardiac abnormalities in a national cohort of SCD victims with CHD, their socioeconomic status and interactions with the healthcare system before death. Methods The Swedish study of Sudden cardiac Death in the Young, 2000-2010 included SCD victims under 36 years, along with population-based controls and their parents. Of 903 SCD victims, 39 with autopsy-defined CHD were included in this study, together with 195 controls. Information on socioeconomic variables and healthcare contacts was gathered from Swedish national registers. Results The median age for SCD was 24 years, 64% were male. The CHD was undiagnosed before death in 31% of the cases, of whom 8 had coronary anomalies. Moderate to complex CHD was observed in 41%. Structural abnormalities of the ventricles were prevalent, with left ventricular hypertrophy present in 56% and fibrosis in 64%. The cases had a higher frequency of hospital admissions within 6 months before SCD compared to controls (OR 14.1,95% CI 3.80-52.44), p < 0.001. No socioeconomic differences were observed. Conclusions This study identified a broad spectrum of underlying anatomical defects, with ventricular structural abnormalities being a common autopsy finding. The majority of cases had moderate to severe lesions. An increased frequency of healthcare contacts prior to death was noted, which may be a variable needing more attention, as a predictor for a higher risk of SCD.

Pathology of an unusual outbreak of fatal disease associated with mycobacterial and Pseudomonas aeruginosa infections and intracytoplasmic inclusion bodies in juvenile spectacled caimans (Caiman crocodilus).

Pathology of an unusual outbreak of fatal disease associated with mycobacterial and Pseudomonas aeruginosa infections and intracytoplasmic inclusion bodies in juvenile spectacled caimans (Caiman crocodilus).

Unusual greenish tissue discoloration in fatal aluminium phosphide poisoning: clinical and forensic perspectives

Aim: Aluminum phosphide poisoning poses significant challenges both in clinical and forensic settings due to its high fatality rate and diverse clinical manifestations. While the clinical symptoms of aluminum phosphide toxicity are well-documented, certain autopsy findings, particularly a rare greenish discoloration of organs, remain poorly understood. Methods: A prospective observational study was conducted over an eight-month period to analyze the occurrence of unusual green discoloration of tissues during autopsies in aluminum phosphide poisoning cases. This study aimed to document the frequency, distribution, and potential mechanisms behind this rare phenomenon, providing insights into its clinical and forensic implications. Results: A total of 110 suspected poisoning cases were examined, of which 47 were confirmed as aluminum phosphide poisonings. Among these, three cases demonstrated gradual greenish discoloration of organs such as the heart, stomach, brain, and kidneys. Despite the presence of this unique discoloration, histopathological examination revealed no microscopic pigmentation or histological anomalies. The discoloration varied in terms of the organs involved, intensity, and the speed of onset, presenting distinct patterns across the cases. Conclusions: The etiology of this discoloration remains unknown, suggesting that biochemical or metabolic processes might play a role. This rare phenomenon underscores the need for further research to elucidate the underlying mechanisms, and highlights the importance of documenting such observations in forensic reports.

Abdominal ultrasound has inconsistent agreement with subsequent surgery or necropsy findings in dogs and cats with septic peritonitis.

To evaluate whether abdominal ultrasound correctly diagnosed septic peritonitis and correctly identified its causative lesion in dogs and cats. 84 client-owned dogs and 10 cats that underwent an abdominal ultrasound and had confirmation of septic peritonitis via exploratory laparotomy or necropsy. This retrospective case series documented abdominal ultrasound findings, surgical or necropsy findings, and method for initial diagnosis of septic peritonitis, if different from surgery or necropsy. The surgical report and necropsy findings were compared to sonography results to confirm a diagnosis of septic peritonitis. The frequency at which sonography diagnosed septic peritonitis and its causative lesion was calculated for each type of lesion pathology and organ system. Secondary aims included evaluating the effect of patient characteristics (body weight and species) on sonographic results and whether lesion type or location affected mortality. Most lesions causing septic peritonitis (70.2%) were gastrointestinal in origin and were nonneoplastic ulcerations or perforations (50%). Abdominal ultrasound diagnosed 56.3% of cases of subsequently confirmed septic peritonitis and correctly identified 67% of the causative lesions. Lesions of the gastrointestinal tract and ulcerations/perforations were the most frequent correct sonographic diagnoses and most likely to lead to a correct sonographic diagnosis of septic peritonitis. Lesions located in the hepatobiliary system and lesion types other than neoplasia or ulcerations/perforations were the most frequently missed by abdominal ultrasound. Abdominal ultrasound often fails to diagnose septic peritonitis or the underlying causative lesion, and its accuracy depends on the affected organ and type of lesion.

Correlation between epicardial fat volume and postmortem radiological and autopsy findings in cases of sudden death: A pilot study

Correlation between epicardial fat volume and postmortem radiological and autopsy findings in cases of sudden death: A pilot study

CT-Imaging Manifestations and Diagnostic Insights in Pulmonary Intravascular Large B-Cell Lymphoma: A Case Series and Literature Review.

Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. Although autopsy findings have revealed that IVLBCL often involves the lungs, its clinical features and imaging manifestations have rarely been reported. This study aimed to explore the pulmonary imaging manifestations of three patients with pulmonary IVLBCL. We retrospectively reviewed the clinical data and chest computed tomography (CT) images of three patients diagnosed with pulmonary IVLBCL between January 2010 and July 2023 in our hospital. In this case series, three patients (2 males and 1 female, aged 51-65 years) presented with a variety of symptoms. Laboratory tests revealed elevated lactate dehydrogenase levels in all three individuals. Chest CT scans revealed bilateral ground-glass opacities (GGOs) in the lungs in all cases. Although previous case reports have often depicted GGOs as ill-defined, two of the three cases manifested multiple well-circumscribed GGOs. Two cases underwent fluorodeoxyglucose positron emission tomography (FDG) PET/CT scans, which showed increased FDG uptake in pulmonary lesions (SUVmax values of 1.9 and 1.7, respectively). Chest CT images of patients with pulmonary IVLBCL mainly manifested as bilateral GGOs of the lungs, with ill-defined GGO infiltrations being more common. FDG PET/CT demonstrates high diagnostic sensitivity for detecting pulmonary involvement in IVLBCL. Even when chest CT scans reveal no visible abnormalities, FDG PET/CT can detect enhanced metabolic uptake in areas with lesions for certain patients.

Case Study: Salmonella – Associated Abortions in Chinchillas – Insights from Microbiological and Necropsy Findings

Abstract Salmonella spp. infections pose a significant threat to both animal and public health, with various serotypes affecting a wide range of hosts. This case report investigates an outbreak of salmonellosis on a chinchilla farm in Serbia, focusing on the clinical, pathological, and microbiological aspects of the infection. Two chinchilla cadavers were brought to the Faculty of Veterinary Medicine, University of Belgrade. The animals on the farm exhibited anorexia, apathy, diarrhea, and abortions before succumbing to the infection. Pathohistological findings revealed severe necrohaemorrhagic metritis and placentitis, along with multifocal randomly dispersed areas of necrosis in the liver. Conventional microbiological analysis revealed the presence of Salmonella Typhimurium which was confirmed by serological typing. Antimicrobial susceptibility analysis showed that bacteria were susceptible to all tested antibiotics. The outbreak could maybe attributed to inadequate husbandry practices and stress, particularly among gravid females. This report underscores the importance of proper husbandry, judicious antibiotic use based on susceptibility testing and implementation of preventive measures to mitigate the recurrence and spread of salmonellosis in chinchilla populations, both in farm and pet settings.

Unexplained Coma and Sudden Death in Psychiatric Patients Due to Self-Induced Water Intoxication: Clinical Insights and Autopsy Findings From Two Fatal Cases

Unexplained Coma and Sudden Death in Psychiatric Patients Due to Self-Induced Water Intoxication: Clinical Insights and Autopsy Findings From Two Fatal Cases

Fatal Non-thrombotic Pulmonary Embolism after Vaginal Filler Injection: A Report of Two Autopsy Cases and Literature Review

Non-thrombotic pulmonary embolism (NTPE) is a rare but potentially fatal complication of filler injections. It can result not only from direct intravascular injection but also from the migration of fillers into veins due to local pressure. Here, we report the autopsy findings of two deaths resulting from NTPE following vaginal filler injections. The first case involved a 38-year-old woman who lost consciousness 20-40 minutes after receiving an injection of 15 mL of hyaluronic acid (HA) filler. A large amount of filler was observed in the vagina with gross embolization of the paravaginal vessels. Microscopic examination revealed HA embolism in the lungs. Despite treatment, the patient died 10 days after the procedure. The second case involved a 35-year-old woman who experienced desaturation and cardiac arrest 4 minutes after receiving a collagen filler and a hybrid filler consisting of HA and polylactic acid. An autopsy revealed NTPE and systemic embolism of the collagen filler. She died 1 month after treatment in the intensive care unit. The vagina poses a significant risk for filler injections owing to its rich venous plexus. Doctors should be fully aware of this risk, and a complete autopsy should be performed in such cases.

Primary Pulmonary Hypoplasia With Congenital Alveolar Dysplasia Associated With TBX4 Gene Deletion: A Case With Autopsy and Molecular Findings.

Acute respiratory distress in a neonate is a potentially critical condition with multiple possible causes. Developmental etiologies are particularly problematic by virtue of being refractory to routine modalities for enhancing ventilation and oxygen exchange. Some genetic causes of neonatal respiratory distress, such as surfactant protein deficiencies and alveolar capillary dysplasia with misalignment of pulmonary veins, are well known, and sequencing panels have been formulated to detect them. We present a case of fatal neonatal respiratory insufficiency in which the autopsy showed primary pulmonary hypoplasia and congenital alveolar dysplasia. A sequencing panel of genes associated with heritable pulmonary disorders gave a normal result; however, a chromosomal microarray identified a heterozygous deletion encompassing the TBX4 gene on chromosome 17. Haploinsufficiency for TBX4 is a known cause of disturbed pulmonary development. This case illustrates why work-up of pulmonary developmental disorders must look beyond standard sequencing panels in some instances, if rare causes of pulmonary maldevelopment such as deletions causing haploinsufficiency are not to be missed.

Peritoneal carcinomatosis after lumboperitoneal shunt in a patient with a cancer of unknown primary site: Case report and review of the literature.

Peritoneal carcinomatosis after lumboperitoneal shunt in a patient with a cancer of unknown primary site: Case report and review of the literature.

Etiology and risk factors of hemorrhagic abomasitis in goat kids

Hemorrhagic abomasitis, also known as Salivary Abomasum Disease (SAD), is a largely under-researched condition affecting young lambs and kids, often leading to high mortality rates and significant economic losses. The disease’s etiopathogenesis, risk factors, and clinical features remain poorly understood. Existing studies have been limited and fragmented, leading to misdiagnoses and confusion about its true nature. Given the lack of a comprehensive investigation into SAD’s incidence, risk factors, and causative agents, this study aims to provide a thorough analysis through clinical, necropsy, histopathological, microbiological, and molecular examinations. This study involved 633 kids, with 323 in the SAD group and 310 in the control group. A multifaceted approach was utilized, encompassing clinical evaluations, necropsies, histopathological assessments, risk factors, and microbiological and molecular analyses, focusing on investigating virulence genes. During the kidding season, 323 deaths were linked to SAD, with a mean disease duration of 1.34 ± 0.54 days. The highest incidence occurred in the 8–14 day age group, accounting for 51.7% of cases (p < 0.05). The dominant clinical symptoms included weakness, lethargy, depression, failure to suckle, reluctance to move, significantly reduced mobility, unsteady gait, and a withdrawn demeanor. Necropsy findings consistently showed dark hemorrhagic content in the abomasum and characteristic “coffee grain” lesions, with no abnormalities in other organs. Escherichia coli was isolated in 63% of sampled kids, significantly more than in controls (p < 0.03), and confirmed through molecular analysis. Examination of virulence genes highlighted the presence of hlyA, stx1, cnf1, stx2, and eaeA in complex combinations linked to severe abomasum damage. Poor bed and bottle hygiene were identified as the primary risk factors for SAD (p < 0.001), with risk escalating in the later stages of the kidding season as farm conditions deteriorated. This study thoroughly re-evaluates hemorrhagic abomasitis in young kids, delivering valuable and reliable insights into this fatal disease. Based on multifaceted analyses, it strongly indicates E. coli as the primary causative agent.

Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source: Case Study in Iatrogenic Infection and Our Approach.

Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.

Remarkable spine erosion in cardiovascular syphilis - Computed tomography reconstruction of a century-old forensic case.

This is the most intriguing museum specimen of cardiovascular syphilis, collected in the Forensic Museum founded by professor Milovan Milovanović (1884-1948) in 1923, the first professor of Forensic Pathology in the newly established University School of Medicine in Belgrade. We aimed to analyze the specimen of an autopsy case from the year 1929 in which severe thoracic spine erosion occurred due to syphilitic aneurism and to demonstrate findings by multi-detector computed tomography (MDCT). The specimen comprises an en-block-eviscerated heart, thoracic aorta, thoracic spine, and posterior segments of the ribs, with a partial section of the heart and a longitudinal section of the aorta. We performed histology and MDCT analyses almost a century after the autopsy and revised the original case documentation. The conducted analyses confirmed the characteristic pathology. Most importantly, MDCT imaging revealed intriguing destruction of the vertebral bodies by the pulsatile saccular aneurysm of the descending aorta. The calcified aneurysm led to the extensive irregular mechanically caused osteolysis of the anterior segments of the several vertebral corpora. After the analysis and revision of the original case documentation, we discussed these findings, as well as additional characteristic autopsy findings in syphilis-related deaths, some of which might be forgotten. The direct close contact of the syphilitic aortic aneurysm with the thoracic spine was preserved. By utilizing postmortem MDCT and 3D reconstruction, we better visualize the thoracic spine bone resorption and alteration: in the time of Milovanović, only roentgenography was available, providing less detail.

A Case of Acute Hemorrhagic Necrotizing Encephalitis in the Neonatal Period: Case Report with Autopsy Findings.

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated disease in children that could progress rapidly, and lead to significant morbidity or mortality. ANE's diagnostic challenges render it difficult to recognize and treat in a timely and effective manner. Although infantile-onset cases have been reported, the presentation of ANE in preterm neonates has not been described. Herein, we report a case of a preterm newborn who had a relatively stable clinical course in the first week of life, after which the neonate exhibited sudden deterioration due to progressive encephalopathy with refractory status epilepticus. Despite aggressive management of seizures and sepsis, the patient succumbed. Whole-exome sequencing analyses of the patient and parents were negative. Viral and metabolic testing were non-contributory. An autopsy showed evidence of acute to subacute fulminant liquefactive necrosis with extensive hemorrhage diffusely in the cortex with relative sparing of the cerebellum and the brainstem. A major consideration highlighted by this case is that the adaptive immune response to the immune-mediated or cytokine storm-related proposed etiology of acute necrotizing encephalopathy may differ in preterm compared with full-term infants due to properties dictated by their innate immune responses. Clinical suspicion of ANE should be heightened whenever preterm neonates with early sepsis continue to deteriorate despite aggressive management.

Clinical decision points for two plasma p-tau217 laboratory developed tests in neuropathology confirmed samples.

We evaluated the diagnostic performance of two commercial plasma p-tau217 immunoassays compared to cerebrospinal fluid (CSF) testing and neuropathology. One hundred and seventy plasma samples from the University of British Columbia Hospital Clinic for Alzheimer's (AD) and Related Disorders were analyzed for p-tau217 using Fujirebio and ALZpath assays. Decision points were determined using CSF testing and autopsy findings as the standard. Fujirebio and ALZpath p-tau217 had similar overall analytical and clinical performance, with distinct decision points for each assay. Based on autopsy findings, both p-tau217 assays identified individuals with AD from other neurodegenerative diseases (ALZpath area under the curve [AUC]=0.94, Fujirebio AUC=0.90). The ALZpath assay detected AD pathology at milder disease stages compared to the Fujirebio assay. Our study reinforces the clinical utility of plasma p-tau217 as an AD biomarker. Differences in test performance and clinical decision points suggest an assay-specific diagnostic approach is required for plasma p-tau217 in clinical practice. Two commercially available p-tau217 immunoassays (ALZpath and Fujirebio) showed equal performance based on CSF testing.ALZpath p-tau217 showed higher performance compared to Fujirebio p-tau217 based on AD diagnosis by neuropathology confirmation.Specific plasma p-tau217 assays may require distinct decision points for AD screening, diagnosis, and disease progression monitoring.

Two cases of Sexual Activity-Related Deaths due to Vascular Dissection: investigating the Potential Link to phosphodiesterase type 5 inhibitor administration.

Sexual activity-related sudden death (SArSD) is an uncommon phenomenon in forensic pathology, typically associated with preexisting vascular abnormalities that rupture due to sudden changes in blood pressure or heart rate during sexual activity. The current report presents two cases of SArSD in men with positive anamnesis for chronic sildenafil use. In Case 1, the cause of death was determined to be an intracranial hemorrhage that occurred shortly before sexual intercourse. In Case 2, death was attributed to the rupture of an abdominal aortic aneurysm, occurring during sexual activity and linked to substance abuse. While both deaths were attributed to SArSD, the potential role of sildenafil in promoting aneurysm formation or rupture remains a subject of debate. Intracerebral hemorrhages associated with sildenafil use appear to exhibit a consistent pattern, commonly affecting the basal nuclei, thalamus, and adjacent cerebral regions, particularly the lateral temporal lobe. Notably, in many cases descri-bed in literature sildenafil doses exceeding 50 mg were reported. The combined effects of sildenafil and substances (such as cocaine) in such events remain largely unexplored, underscoring the need for further research to elucidate their interaction. Cases of vascular dissections occurring independently of sexual activity suggest that sildenafil use warrants caution, particularly in individuals with underlying vascular vulnerabilities. Although rare clinical cases and autopsy findings have suggested a potential association between phosphodiesterase type 5 inhibitors (PDE5i) and hemorrhagic events, such as intracerebral hemorrhages or aneurysm ruptures, current evidence does not indicate that PDE5i have a significant or direct impact on blood pressure capable of causing the acute rupture of a healthy vessel. Nevertheless, further clinical and forensic studies are essential to elucidate the relationship between chronic or acute PDE5i use and hemorrhagic cerebrovascular accidents or aortic dissections.