Extensive Hemorrhagic Infarction Research Articles

Delayed Death Due to Methanol Poisoning: An Autopsy Case Report

Methanol is a non-drinking type of alcohol used for industrial and automotive purposes. Methanol itself is not dangerous, but its harmful metabolites may cause the accumulation of acid in the blood, leading to metabolic acidosis, permanent blindness, and death. In this case report study, the case was a 28-year-old Nepalese man who was admitted in a semi-unconscious state to the emergency department. A working diagnosis of methanol poisoning was made. After more than two weeks, he succumbed to death due to a worsening cerebral infarction. At autopsy, extensive hemorrhagic infarction was observed, involving bilateral cerebral hemispheres. Well-defined subcortical hemorrhages leading to laminar necrosis were seen at the frontoparietal lobes. Cystic or lacunar necrosis was present at the basal ganglia. The brainstem showed the presence of duret hemorrhage. The man died approximately three weeks after the methanol ingestion. This case highlights the important pathological changes and accumulating effects of methanol in the brain.

An Atypical Presentation of Spontaneous Infarction of Uterus and Appendages

Spontaneous infarction of the uterus is an extremely rare condition with unknown etiology. Uterine fibroids are benign mesenchymal tumors and sometimes infarction can occur after uterine artery embolization or torsion in the fibroid. We report a delayed and neglected case of uterine fibroid, which caused spontaneous infarction of the whole uterus and its appendages in a 39-year-old unmarried woman. She was presented with severe pallor and dyspnea for which she was kept in the intensive care unit to stabilize her condition. The patient had a history of an abdominal mass for 10 years which was first diagnosed as fibroid of 7cm. The patient was planned for laparotomy, bilateral salpingo-oophorectomy, total abdominal hysterectomy and omentectomy. The intra-operative finding showed a huge infarcted uterine mass with congested and massively necrosed ovaries and tubes. Histopathological examination reported polyp presence in hemorrhagic infarction. Sections from mass, tubes and ovaries showed extensive hemorrhagic infarction with congested vessels. The patient was discharged satisfactorily with no post-operative complications. Keywords: Infarction; Uterus; Leiomyoma.

Correlation of ultrasonographic types of breast fibroadenomas with pathologic findings

Objective To explore the correlation of ultrasonographic,pathologic,and clinical findings of breast fibroadenomas.Methods 157 cases of breast fibroadenomas demonstrated by pathologic findings were examined with color Doppler ultrasound prior to biopsy.Images were classified according to ultrasound characteristics and analysed with latter pathologic findings.Results Ultrasound images of 157 cases could be divided into 6 types:uniformity( n =82),linage( n =37),bicolor( n =15),nodule-in-nodule (n =3),cyst-massity mixed ( n =9),calcify( n =11).5 cases were mistakenly judged to breast cancer on ultrasound images(1 ease in the linage,1 case in the cyst-mass mixed,3 cases in the calcify).Accurate ratio of ultrasound diagnosis was 96.82％.Pathologic finding:①Uniformity type,hyperplasia of both the gland and fibrous tissue of tumor in order.② Linage type,hyperplasia fibrous tissue in belt.③ Bicolor type,significant difference in the proportion and arrangement of the hyperplasia gland and fibrous tissue.④Nodule-in-nodule type,extensive hemorrhagic infarction in tumor.⑤Cyst-massity mixed type,hydatoncus,metaplasia in great sweat gland,hyperplasia conduit epithelial,conduit cystic-expansion.⑥ Calcify type,fibroadenomas on growth of static or regression transformation,and calcify of interstitial tissue.Conclusions Ultrasonic diagnosis and its simple typing is an accurate,simple and effective way for the diagnosis of breast fibroadenoma,which may improve the accuracy of diagnosis rate for breast fibroadenoma.It is helpful for choosing the surgical remedies. Key words: Ultrasonography, mammary; Breast diseases ; Fibroadenoma

Chronic superior sagittal sinus thrombosis with phlebosclerotic changes of the subarachnoid and intracerebral veins

An autopsy case of chronic thrombotic occlusion of the superior sagittal sinus (SSS) with an unusually protracted clinical course is reported. The patient was an 84-year-old man without any predisposing conditions for thrombosis. The clinical features were atypical and were characterized by recurrent cerebral subcortical hemorrhages. The autopsy revealed a large, organized thrombus in the SSS and extensive hemorrhagic infarction of the bilateral parasagittal region of the cerebral hemispheres. The hemorrhagic infarction was comprised of the aggregation of numerous minute foci of coagulation necrosis associated with petechial hemorrhages. Marked phlebosclerotic changes were observed in the subarachnoid and intracerebral veins, which were considered to be reactive changes of the venous walls against a persistent elevation in peripheral venous pressure caused by thrombosis of the SSS.

Recurrent bowel infarction in paroxysmal nocturnal haemoglobinuria

A man of 43 was referred after 24 hours of feeling generally unwell with intermittent rigors. PNH had been diagnosed 18 years previously, and regular blood transfusions for his anaemia had resulted in iron-overload diabetes mellitus. 8 years before the present episode he had had a small-bowel resection for ischaemia secondary to venous thrombosis. On examination his abdomen was distended and slightly tender in the left lower quadrant, without obvious peritonism. Haemoglobin was 6.4 g/dL and platelet count 166109/L. Blood indices were otherwise normal. A plain abdominal X-ray showed dilated small-bowel loops. Adhesional small-bowel obstruction was diagnosed and initial management was conservative. After three days the abdominal distention had not resolved and a CT scan (Figure 1) showed gross small-bowel dilatation with an area of collapsed small bowel distally, highly suggestive of a mechanical obstruction. At laparotomy, with bloodtransfusion and platelet cover, he was found to have a segment of gangrenous small bowel with a stricture. This was resected and the bowel was anastomosed by an extramucosal technique. The patient spent the first three postoperative days on the intensive care unit for close monitoring, and received total parenteral nutrition for five days until enteral feeding was started. No further blood or platelet transfusions were required. Histopathological examination of the operative specimen showed extensive haemorrhagic infarction secondary to venous thrombosis.

Acute myelopathy secondary to spinal venous thrombosis

A 66-year-old female presented with the acute onset of paraplegia progressing rapidly to quadriplegia and terminating fatally in less than a month. At autopsy extensive hemorrhagic infarction of the spinal cord was noted associated with widespread venous thrombosis. Other similar cases are reviewed and the pathophysiology is discussed.

Fatal bowel infarction and sepsis: An unusual complication of systemic strongyloidiasis

A 58 year old Chinese male, one week after arriving in Canada from Hong Kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by Escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of Strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome ( Marcial-Rojas, 1971 ). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions ( Brown and Perna, 1958 ; Huchton and Horn, 1959 ). Similarly, in patients on steroid ( Cruz et al., 1966 ; Willis and Mwokolo, 1966 ; Neefe et al., 1973 ) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response ( Rogers and Nelson, 1966 ; Rivera et al., 1970), systemic strongy loidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis ( Brown and Perna, 1958 ; Huchton and Horn, 1959 ). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.