Accuracy of magnetic resonance imaging in determining cause of sudden death in adults: comparison with conventional autopsy

AIM: To determine the accuracy and define the limitations of post mortem magnetic resonance imaging (MRI) in determining the cause of sudden death in adults. METHODS AND RESULTS: Sudden unexpected adult deaths in the community, reported to the Coroner (n = 10), excluding suspicious, violent or potentially drug-related deaths, were submitted to whole body MRI, followed by full invasive autopsy. The MRI scans were reported independently by four radiologists, blinded to the autopsy findings; two had previous experience of post mortem MRI. An abnormality that related to the cause of death as identified at autopsy, was identified by at least one radiologist in eight cases. These were pulmonary consolidation (autopsy finding pneumonia) (n = 1), pneumoperitoneum (autopsy finding perforated peptic ulcer) (n = 2), left ventricular failure (autopsy finding ischaemic heart disease) (n = 4), and disseminated bronchial carcinoma (n = 1). However, in only one case were all radiologists able to provide a confident cause of death (disseminated bronchial carcinoma). In two cases, in which death occurred 2-6 days and 3-6 days before MRI, early decomposition prevented interpretation of the images. Severe coronary artery atheroma was detected at autopsy in 7/10, but these lesions were not detected by MRI. Previous experience in reporting post mortem MRI, without autopsy comparison, did not result in more accurate interpretation of the images. CONCLUSIONS: This pilot study suggests that post mortem MRI can identify some abnormalities relating to the common causes of sudden death in adults, but there is a need for greater experience in correlating MRI with autopsy findings before a reliable cause of death can be made by MRI alone. Inability to image coronary artery lesions, differentiating thrombus from clot and pulmonary oedema from pneumonic exudates, are specific problems that may be corrected with greater experience and higher resolution scans.     

105例尸体解剖的病理学分析

目的：剖析不明原因死亡的疾病分布及引起死亡的原因。探讨死亡所发生的病理学特点及猝死的发生机制。方法：收集不明原因死亡的尸体解剖材料105例,进行组织病理学检验,部分做了法医学的毒物分析。结果：在105例尸检中,21-40岁青壮年81例,为第一高峰,其中病理性死亡81例,暴力性死亡24例,猝死35例;89.5%找到死亡的主要疾病,疾病的分布以心血管最常见,共22例,其次呼吸系统,中毒,神经系统以及其他疾病。结论：科学准确地进行尸体解剖。不但可明确死因。而且丰富和发展相关临床学科的内容。对提高诊治水平具有重要意义。     

Feasibility of liver weight estimation by postmortem computed tomography images: An autopsy study

Although organ weight gives pathologists information about the pathogenesis of diseases at autopsy, the knowledge is rarely helpful in postmortem virtual autopsy by computed tomography (CT). To investigate the feasibility of liver weight estimation based on liver volume estimated from three‐dimensional CT images and the specific gravity of liver, thirty cadavers who died in the University of Fukui Hospital and whose family members agreed to postmortem CT and autopsy were prospectively enrolled. Mean specific gravity of liver was 1.054 ± 0.009 g/mL (95% confidence interval: 1.0507–1.0573 g/mL). The specific gravity was positively correlated to Hounsfield unit (HU) values of less than 40 (cases with moderate to severe fatty deposition) and remained stable between 1.05 to 1.065 g/mL for HU values greater than 40 (cases with mild or no fatty change). The liver weight estimated by our formula corresponded well to the actual liver weight, and the correlation coefficient was 0.96 (P < 1 × 10^?13). The estimated liver weight calculated from estimated liver volume and the specific gravity of 1.055 g/mL was highly accurate, whereas the specific gravity should be reduced by 2%–3% in patients with an HU value less than 40 due to fatty deposition.     

以皮肌炎样表现为特征的血行播散性结核--附3例尸检

目的：为了避免临床误诊,对结核病的肌肉病变特点进行探讨。方法：复习２５例经尸检证实为急／亚急性血播散性结核的病例,其中３例临床上主要表现为皮肤和肌肉损害,分别在患者生前诊断为皮肌炎（２例）和多发性硬化症（１例）。对其骨骼肌进行详细的镜下观察。结果：四肢肌、膈肌、食道和喉的横纹肌均有程度不同的变性、坏死和淋巴细胞浸润,表现为：（１）肥大或萎缩;（２）嗜酸性、玻璃样和絮状变性;（３）溶解和凝固性坏死;     

“Donating our bodies to science”: A discussion about autopsy and organ donation in Turner syndrome

At the Third Turner Resource Network Symposium, a working group presented the results of collaborative discussions about the importance of autopsy in Turner syndrome (TS). Considerable gaps in understanding the causes of death in TS can only be closed by more frequent death investigations and autopsies. The presentation included an overview of autopsy methods, strategies for utilizing autopsy, and biobanking to address research questions about TS, and the role of palliative care in the context of autopsy. This review highlights strategies to promote autopsy and tissue donation, culminating with an action plan to increase autopsy rates in the TS community.     

猝死37例死因分析

目的 分析不明原因死亡患者的疾病分布及尸检病理学特点。方法 收集不明原因死亡尸体107例,解剖结果显示37例为猝死,占35％,对其进行组织病理学检查。结果 37例猝死的疾病分布以心血管最常见,共16例,占43．2％,其次为呼吸系统、神经系统、消化系统疾病。结论 通过尸体解剖和病理学检查,为解决医疗纠纷和明确猝死死因提供科学的鉴定依据,对提高医疗质量起到积极的作用。     

恶性组织细胞增生症7例尸检报道

本文对7例恶性组织细胞增生症尸检的临床和病理学改变进行了分析,其病理特点为:系统性、进行性、浸润性、弥漫性生长,瘤细胞具多形性和吞噬性,并对外周淋巴结活检、骨髓穿刺涂片在诊断中的意义,瘤细胞的分化与生存期长短的关系进行了讨论。     

心源性猝死33例尸检临床病理分析

目的 分析心源性猝死的临床特点以及尸检病理学特征.方法 收集与医疗纠纷有关的不明原因死亡的87例尸体解剖资料进行病理组织学检查.结果 心源性猝死33例,其中,冠心病20例(占64%),主动脉夹层动脉瘤破裂4例,心肌炎5例,肥厚性心肌病2例,冠状动脉炎和肺动脉脂肪栓塞各1例.结论 正确、系统地进行尸体解剖,可以明确猝死原因,提高医疗质量,并为医疗纠纷鉴定提供可靠的鉴定依据.     

先天性腹壁缺损36例尸体解剖和组织学观察

目的：探讨腹壁缺损的病理形态学变化,方法：对36例腹壁缺损进行尸体解剖,按照Hartwig方法分型,并对24例不同组织和胎盘进行组织学观察。结果：36例腹壁缺损多伴有其它畸形,包括肢体,颜面,神经管,泌尿生殖及消化和心血管系统,腹壁缺损皮肤－膜移行区为复层扁平上皮逐渐向意志层上皮过渡,间质由丰富胶原纤维变为疏松的结缔组织,证实了羊膜外胚层过渡带的存在。5例肾脏和1例脑组织中发策钙化病灶,胎盘表现绒毛发育不同步,绒毛间质水肿或纤维化,有血管增生,血栓形成等变化。部分病例提示有绒毛炎,13例孕母曾有TORCH感染,11例胎儿脏器TORCH PCR－DNA扩增检测阳性,结论：在胚胎腹壁形成期,如果受到某些致畸因素的干扰,除发生腹壁缺损外,还将出现多种复杂畸形,腹壁缺损的致畸因素不能除外TORCH如巨细胞病毒等感染的可能。     

Clinicopathological findings in fulminant-type pneumococcal infection: report of three autopsy cases

Reported herein are three autopsy cases of fulminant-type pneumococcal sepsis with disseminated intravascular coagulation (DIC) resulting in death within a few days of onset of symptoms. Two of the three patients had previously had a splenectomy because of a hematological disorder. None of the patients had received pneumococcal vaccination. On post-mortem every organ had congestion as well as bleeding. Interestingly, severe inflammation of the alveoli was absent despite the sepsis. The cause of death was rapidly progressive pneumococcal sepsis leading to DIC and circulatory failure, which appeared to cause pulmonary congestion and hemorrhage without pneumonia. It is important to understand the pathogenesis of fulminant-type pneumococcal infection because it is life-threatening for compromised hosts.     

Invasive fungal disease in university hospital: a PCR-based study of autopsy cases

Invasive fungal disease (IFD) has high mortality rate, especially in the growing population of immunocompromised patients. In spite of introduction of novel diagnostic approaches, the intravital recognition of IFD is challenging. Autopsy studies remain a key tool for assessment of epidemiology of visceral mycoses. We aimed to determine species distribution and trends of IFD over the last 10 years in unselected autopsy series from a large university hospital. Forty-five cases of visceral mycoses, confirmed by histopathology and panfungal PCR, were found in 587 consecutive autopsies. Major underlying diseases were diabetes mellitus (20%), hematologic malignancies (15.6%) and systemic lupus erythematosus (15.6%). There was a high risk for disseminated IFD in immunocompromised patients stayed in the hospital over 1 month with a fever longer than 3 weeks. The most common fungi were Aspergillus spp. (58%), Candida spp. (16%), Mucorales (14%) and Fusarium spp. (10%). We found significant increase in Aspergillus flavus (P = 0.04) and Mucorales (P < 0.01) infections over the last 5 years. Concordance rate between histopathology and panfungal PCR was 89.5% to the genus level. All 6 cases of fusariomycosis were misinterpreted as aspergillosis by histology alone. The precise species identification, necessary for targeted antifungal treatment, was rendered only by the molecular technique. Panfungal PCR showed high performance on formalin-fixed paraffin-embedded specimens, providing important epidemiological data in retrospective autopsy series. Rapid detection of fungi by panfungal PCR assay has high potential for intravital diagnostics of IFD in surgical and biopsy specimens.     

Secondary tumors of the pancreas: Clinicopathological study of 103 autopsy cases of Japanese patients

To investigate the clinicopathological features of patients with secondary tumors of the pancreas, we reviewed autopsy records and pathological features of 103 cases with pancreatic secondary tumors from 690 cases of malignant tumors (excluding cases of primary pancreatic cancer) over a 10-year period. There were 67 men and 36 women in the study, ranging in age from 2 to 94 years (mean: 61 years). The incidence of pancreatic secondary tumors was 15% in the autopsy cases of malignant tumors, and the majority of the secondary tumors were carcinomas. The stomach was the most common primary tumor site (20%), followed by the lung (18%) and extrahepatic bile duct (13%). Because the total number of each primary carcinoma differed, we paid specific attention to the incidence of pancreatic metastasis in each primary carcinoma. We found that carcinoma of the papilla of Vater showed the highest rate of incidence (75%) of pancreatic metastasis in each type of primary carcinoma. Approximately half of the metastatic lesions were solitary, but the metastatic lesions in the pancreas could not be identified macroscopically in 34 cases (33%). Histologically, the most common carcinoma was adenocarcinoma, followed by large cell carcinoma, small cell carcinoma and neuroendocrine carcinoma. The most common non-epithelial tumor was leukemia, followed by malignant lymphoma. Undifferentiated carcinoma and neuroendocrine carcinoma were often found in cases of extrahepatic bile duct or urinary bladder carcinoma with pancreatic metastasis. As for the microscopic infiltration patterns of tumor cells, 73% of cases showed an interlobular and intralobular infiltration. Fat necrosis was most frequently seen as an associated pathological finding (19%). Our study indicates that secondary tumors of the pancreas can be found in approximately one out of six to seven autopsy cases of malignant tumors, and in Japan, the most common of these is adenocarcinoma of the stomach.     

先天性室管膜母细胞瘤尸检分析并文献复习

目的探讨先天性室管膜母细胞瘤的临床及组织病理学特征。方法对1例经尸检诊断的先天性室管膜母细胞瘤的组织病理学、免疫组织化学、超微结构以及DNA倍体情况进行研究,并结合文献复习。结果孕中经B超发现的颅内肿瘤,经尸检确定位于左颞叶近侧脑室后角处,直径约3.5 cm。肿瘤细胞胞核致密浓染,胞质少,密集成团形成具有复层细胞和近腔处活跃核分裂特征的菊形团。免疫组化结果示肿瘤细胞vim entin阳性,GFAP少数阳性。结论室管膜母细胞瘤是一种极少见的神经上皮胚胎性肿瘤,具有特征性的“室管膜母细胞瘤”菊形团结构。肿瘤主要位于幕上,好发于婴幼儿,具有高度侵袭性,预后极差。     

High throughput adult cadaver axial imaging: service logistics and requirements

It remains unknown to date the extent of the potential role of computed tomography (CT) and magnetic resonance imaging (MRI) in autopsy practice in the United Kingdom (UK). If CT and/or MRI were accepted to have a role beyond that already been undertaken within the UK and implemented on a national high throughput scale, what impact would it have upon the National Health System (NHS) where, in the UK, the majority of mortuary facilities and practitioners work? This symposium paper explores the logistics, personnel and facilities that may be required to assist those contemplating developing such a provision of service. The discussion presented is based upon the concept that all cadavers normally subjected to invasive medico-legal (coroner’s) autopsy would be imaged following receipt at an NHS hospital located mortuary. It is based on the experience of the East Midlands Forensic Pathology Unit and Imaging Department, University Hospitals of Leicester in examining cadavers using CT within the NHS where all of these problems have been encountered previously.     

Post-mortem imaging in adults

Post-mortem computed tomography (PMCT), offers a non-destructive approach to the investigation of fatal injuries and the diagnosis of deaths from natural causes. Strengths of PMCT include the demonstration of fractures, internal haemorrhage, vascular disease and tumours. Imaging can be combined with minimally invasive techniques in the investigation of deaths secondary to sepsis, metabolic causes and drug toxicity. Unlike traditional invasive autopsy, PMCT creates an observer-independent permanent record of the findings that is amenable to audit, and may be used for courtroom or other demonstration. In the United Kingdom, PMCT is increasingly used as a first line technique in coronial investigation. The cause of death can be ascertained without open autopsy in the majority of cases. The use of PMCT in the UK is driven by religious and cultural objections to invasive autopsy, a shortage of autopsy pathologists and concerns regarding the quality of autopsies. Despite the backing of the Royal Colleges and the Chief Coroner, a number of logistical and financial challenges must be overcome in developing a national service.     

Analysis of multiple primary cancer autopsy cases associated with breast cancer: 2002–2010

Breast cancer patients have a generally increased risk of developing second cancers. The object of this study was to clarify the increased as well as decreased incidence of cancers in breast cancer patients using autopsy cases. 164 211 autopsy cases in the Annual of Pathological Autopsy Cases in Japan from 2002 to 2010 were analyzed for multiple primary cancer (MPC). Female MPC cases (4222 cases) were selected. We investigated the cancer incidence observed in breast cancer associated MPC. The Chi‐squared test was used for analysis. All P‐values were two‐sided, and differences at P < 0.05 were considered significant. Breast cancer associated MPC showed a significantly increased incidence of ovarian, pancreatic, and skin cancer (Odds Ratio [95 % confidence interval (CI)]) = 1.464 [1.03, 2.08], 1.414 [1.08, 1.85] and 2.092 [1.28, 3.41]), and a decreased incidence of colorectal and cervical cancer (OR [95 % CI]) = 0.732 [0.60, 0.90], 0.605 [0.38, 0.96]). Our findings of an increased incidence of malignancies in breast cancer associated MPC cases were consistent with the results of previous population‐based studies. This study is the first study to analyze massive autopsy data on MPC which provide new evidence clinically and pathologically.     

Clinical and pathological disagreement upon the cause of death in a teaching hospital: analysis of 100 autopsy cases in a prospective study

The aim of the present study was to analyze the concordance between clinical and autopsy diagnoses. For this purpose, 100 patients submitted to autopsy from July 2000 to April 2001 were studied prospectively. In all cases, clinicians gave the immediate and the underlying causes of death for patients dying under their care. The diagnoses were compared to the macroscopic autopsy diagnoses. Cohen's kappa coefficient of agreement was estimated. Sixty-four men and 36 women were submitted to autopsy. The most frequent pathological diagnosis of underlying cause of death were diseases of the circulatory system (35%), infections and parasitic diseases (20%) and diseases of the digestive system (11%). The kappa coefficient for immediate cause of death was 0.40 (95% confidence interval (CI): 0.29–0.50); for underlying cause it was 0.38 (95%CI: 0.18–0.44), and for basic cause codified by group according to ICD-10 it was 0.55 (95%CI: 0.44–0.67). Major disagreement occurred in 10 cases involving pathological causes of death as circulatory diseases, in which the clinicians diagnosed a digestive system disease as the cause of death ( n  = 5), or infectious and parasitic diseases ( n  = 5). The present study shows that agreement between clinical and pathological causes of death are moderate, proving that the autopsy is still a very important procedure.     

Morphological spectrum of renal pathology and its correlation to clinical features in patients with disseminated intravascular coagulation: A study involving a series of 21 autopsy cases

Disseminated intravascular coagulation (DIC), a thrombohemorrhagic disorder, occurs as a secondary complication in many diseases, but the histopathological features of kidneys in DIC have not been extensively characterized thus far. We reviewed 21 autopsy cases of patients with a clinical diagnosis of DIC and studied the repertoire of renal pathology. Eighteen patients had elevated serum creatinine levels and 15 patients had a variable degree of proteinuria. Underlying disorders included malignant neoplasms in 12 patients, and abdominal aortic aneurysm, acute myocardial infarction, and systemic infections in other patients. Coexistent glomerular pathology, such as focal segmental glomerulosclerosis (FSGS) with different morphological variants, and microthrombi formation, was present in many patients. The microthrombi were histologically similar to that seen in thrombotic microangiopathy, but characteristics associated with DIC were detected by special staining. The presence of FSGS correlated with the degree of urinary protein (P = 0.0044), and the presence of acute tubular injury (ATI) and the extent of global glomerulosclerosis both correlated with serum creatinine levels (P = 0.019 and 0.0003, respectively). FSGS was probably due to endothelial cell damage, another potential etiology for FSGS. Global glomerulosclerosis, a result of previous renal injury, can be a determinant of renal function during the acute phase of DIC.     

多发性大动脉炎主动脉破裂尸检及文献复习

目的探讨多发性大动脉炎的临床、病理学特点及鉴别诊断。方法对1例多发性大动脉炎的尸体解剖病例进行病理学检查并复习文献。结果多发性大动脉炎是主要累及主动脉及其主要分支的全血管性非特异性炎症,以动脉管壁增厚、狭窄为主要特征,急性期无特征性症状,可致节段性内膜剥离,形成致命性夹层动脉瘤。结论多发性大动脉炎急性期无特征性症状,容易误诊,对无明显原因胸痛青年患者应提高警惕。