Pub Date : 2024-12-20DOI: 10.1097/PAF.0000000000001007
Garrett Phillips
{"title":"Incidental Finding of an Early-Stage Intrauterine Pregnancy at Autopsy.","authors":"Garrett Phillips","doi":"10.1097/PAF.0000000000001007","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001007","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-13DOI: 10.1097/PAF.0000000000001003
Michael Andrew Johnstone, Sam Hoggard, Joanna Dixon
Abstract: Tension gastrothorax is a rare and potentially fatal complication of a diaphragmatic hernia, in which a massively dilated, intrathoracic stomach compresses the lungs and mediastinum, causing cardiorespiratory compromise, in a mechanism akin to tension pneumothorax. Although it is very rare, tension gastrothorax has been reported in the literature; however, such reports are almost exclusively restricted to its clinical presentation and treatment in emergency departments. To the best of our knowledge, no adult autopsy case reports of tension gastrothorax have been reported in the literature. We present 2 adult autopsy case reports in which we believe the cause of death was tension gastrothorax, followed by a discussion of what a tension gastrothorax is and its potential etiology, and finally, we discuss the difficulties of making the diagnosis at autopsy, including how postmortem computed tomography imaging can be hugely beneficial as it was in one of our cases.
{"title":"Fatal Tension Gastrothorax: Two Case Reports.","authors":"Michael Andrew Johnstone, Sam Hoggard, Joanna Dixon","doi":"10.1097/PAF.0000000000001003","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001003","url":null,"abstract":"<p><strong>Abstract: </strong>Tension gastrothorax is a rare and potentially fatal complication of a diaphragmatic hernia, in which a massively dilated, intrathoracic stomach compresses the lungs and mediastinum, causing cardiorespiratory compromise, in a mechanism akin to tension pneumothorax. Although it is very rare, tension gastrothorax has been reported in the literature; however, such reports are almost exclusively restricted to its clinical presentation and treatment in emergency departments. To the best of our knowledge, no adult autopsy case reports of tension gastrothorax have been reported in the literature. We present 2 adult autopsy case reports in which we believe the cause of death was tension gastrothorax, followed by a discussion of what a tension gastrothorax is and its potential etiology, and finally, we discuss the difficulties of making the diagnosis at autopsy, including how postmortem computed tomography imaging can be hugely beneficial as it was in one of our cases.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1097/PAF.0000000000001004
Ryan Blumenthal, Robert Maximilian
{"title":"Illustrated Forensic Pathology: Necklacing.","authors":"Ryan Blumenthal, Robert Maximilian","doi":"10.1097/PAF.0000000000001004","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001004","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-05DOI: 10.1097/PAF.0000000000000993
Christopher Rogers, Denis Astarita, Lakshmanan Sathyavagiswaran, Patrick Pazmiño, Arturo Ramírez-Montañana
Abstract: One complication of autologous fat transfer into the buttocks (cosmetic injection of fat into the gluteal region) is inadvertent fat embolization. In 2015, our office published a case of macro fat/adipose tissue embolization following fat transfer surgery. Between 2010 and 2018, we had six additional cases of macro/micro fat embolism that caused death. Professional associations and plastic surgeons have recommended ways to avoid fat embolism during fat transfer. In our experience, the risk of fat embolism has decreased in Los Angeles in recent years. Our office has had only one case since 2018 where an unlicensed individual performed the procedure. However, fat embolism is still possible in cases where professional recommendations are not followed. We recommend that the evaluation of possible fat embolus cases include full autopsy with gluteal dissection, microscopic examination of intravascular fat, review of medical and anesthesia records, including whether ultrasound was used during fat grafting, toxicological examination of specimens taken as close to the time of arrest as possible, and anesthesiology consultation.
{"title":"Fat Embolism Fatalities Following Liposuction/Injection in Los Angeles County (2010-2018).","authors":"Christopher Rogers, Denis Astarita, Lakshmanan Sathyavagiswaran, Patrick Pazmiño, Arturo Ramírez-Montañana","doi":"10.1097/PAF.0000000000000993","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000993","url":null,"abstract":"<p><strong>Abstract: </strong>One complication of autologous fat transfer into the buttocks (cosmetic injection of fat into the gluteal region) is inadvertent fat embolization. In 2015, our office published a case of macro fat/adipose tissue embolization following fat transfer surgery. Between 2010 and 2018, we had six additional cases of macro/micro fat embolism that caused death. Professional associations and plastic surgeons have recommended ways to avoid fat embolism during fat transfer. In our experience, the risk of fat embolism has decreased in Los Angeles in recent years. Our office has had only one case since 2018 where an unlicensed individual performed the procedure. However, fat embolism is still possible in cases where professional recommendations are not followed. We recommend that the evaluation of possible fat embolus cases include full autopsy with gluteal dissection, microscopic examination of intravascular fat, review of medical and anesthesia records, including whether ultrasound was used during fat grafting, toxicological examination of specimens taken as close to the time of arrest as possible, and anesthesiology consultation.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-02DOI: 10.1097/PAF.0000000000001002
Naoto Tani, Takaki Ishikawa
{"title":"Human Herpesvirus 6 Encephalitis: An Autopsy Case and Literature Review.","authors":"Naoto Tani, Takaki Ishikawa","doi":"10.1097/PAF.0000000000001002","DOIUrl":"https://doi.org/10.1097/PAF.0000000000001002","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-12DOI: 10.1097/PAF.0000000000000962
Laura M Labay, Sherri L Kacinko, Brittany K Casey, Justin O Brower
A bstract: Tolerance is the diminished response to a drug that occurs when that drug is repeatedly used, and the body adapts to its continued presence. This means that greater blood concentrations are required to achieve desired effects, produce impairment, or cause death. Without case-specific information, the pharmacodynamic impacts of a drug on an individual are difficult to ascertain based on its concentration alone. One starting point, however, is to compare reported findings with reference ranges associated with therapeutic, toxic, and lethal outcomes. Toxicologists have observed concentrations dramatically increase over time in the living population for some drugs to concentrations that can easily be associated with impairment and lethal outcomes. It is, therefore, important to continually monitor and be familiar with drug concentrations found in the living to interpret postmortem concentrations. To emphasize this approach, we compared fentanyl concentrations from JAN 2010 to OCT 2023 in individuals investigated for driving under the influence of drugs to postmortem cases. This comparison highlights the changing nature of tolerance, stresses the importance of not relying solely on reference ranges for result interpretations, and discusses the importance of the autopsy in identifying or ruling out other potential causes of death.
{"title":"Tolerant or Intolerant? Learning From Studying Drug Concentrations in the Living and the Dead.","authors":"Laura M Labay, Sherri L Kacinko, Brittany K Casey, Justin O Brower","doi":"10.1097/PAF.0000000000000962","DOIUrl":"10.1097/PAF.0000000000000962","url":null,"abstract":"<p><strong>A bstract: </strong>Tolerance is the diminished response to a drug that occurs when that drug is repeatedly used, and the body adapts to its continued presence. This means that greater blood concentrations are required to achieve desired effects, produce impairment, or cause death. Without case-specific information, the pharmacodynamic impacts of a drug on an individual are difficult to ascertain based on its concentration alone. One starting point, however, is to compare reported findings with reference ranges associated with therapeutic, toxic, and lethal outcomes. Toxicologists have observed concentrations dramatically increase over time in the living population for some drugs to concentrations that can easily be associated with impairment and lethal outcomes. It is, therefore, important to continually monitor and be familiar with drug concentrations found in the living to interpret postmortem concentrations. To emphasize this approach, we compared fentanyl concentrations from JAN 2010 to OCT 2023 in individuals investigated for driving under the influence of drugs to postmortem cases. This comparison highlights the changing nature of tolerance, stresses the importance of not relying solely on reference ranges for result interpretations, and discusses the importance of the autopsy in identifying or ruling out other potential causes of death.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"292-296"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-20DOI: 10.1097/PAF.0000000000000964
Marianne Tiemensma, Salona Prahladh, Roger W Byard
Abstract: Helicopters are used worldwide in a range of commercial and private industries and are particularly useful in northern Australia due to the sparse population scattered over large distances with remote regions difficult to access by any other means of transport. Nine civilian helicopter-related fatalities were reported to the Northern Territory coroner between January 2004 and December 2023. The victims were all male (age range, 34-74 years; mean, 52 years). All fatal crashes occurred in remote areas, the majority on cattle stations. Pilots were the sole occupants in 5/9 incidents; in 4 incidents, there were injured survivors. All fatal incidents involved Robinson piston engine helicopters (Robinson R44 models in 2 incidents and Robinson R22 models in the remaining 7). Scene investigations, postmortem examinations, and ancillary investigations were frequently hampered by decomposition of the remains, resulting from difficult search operations and delayed location, retrieval, and storage. Head injuries were present in all cases with chest and spinal injuries in more than half. Integrated assessment of injuries with toxicological and aviation investigations facilitated understanding of the crash dynamics.
{"title":"Circumstances and Pathological Findings in Civilian Helicopter-Related Fatalities.","authors":"Marianne Tiemensma, Salona Prahladh, Roger W Byard","doi":"10.1097/PAF.0000000000000964","DOIUrl":"10.1097/PAF.0000000000000964","url":null,"abstract":"<p><strong>Abstract: </strong>Helicopters are used worldwide in a range of commercial and private industries and are particularly useful in northern Australia due to the sparse population scattered over large distances with remote regions difficult to access by any other means of transport. Nine civilian helicopter-related fatalities were reported to the Northern Territory coroner between January 2004 and December 2023. The victims were all male (age range, 34-74 years; mean, 52 years). All fatal crashes occurred in remote areas, the majority on cattle stations. Pilots were the sole occupants in 5/9 incidents; in 4 incidents, there were injured survivors. All fatal incidents involved Robinson piston engine helicopters (Robinson R44 models in 2 incidents and Robinson R22 models in the remaining 7). Scene investigations, postmortem examinations, and ancillary investigations were frequently hampered by decomposition of the remains, resulting from difficult search operations and delayed location, retrieval, and storage. Head injuries were present in all cases with chest and spinal injuries in more than half. Integrated assessment of injuries with toxicological and aviation investigations facilitated understanding of the crash dynamics.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"299-307"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-23DOI: 10.1097/PAF.0000000000000942
Alison Krywanczyk, Thomas Gilson
Increasing rates of infectious endocarditis (IE) are well-described in the United States and worldwide, yet forensic literature regarding IE is sparse. Autopsy databases may help identify subsets of patients at increased risk of mortality. We reviewed all deaths due to IE in our office between 2010 and 2022 (with full autopsy performed) and found 29. The average age was 44 years. Manners of death included natural (69%), accident (28%), and homicide (3%). For all accidental deaths, acute intoxication was included in either part I or II. The aortic valve was most affected (62%), followed by tricuspid (28%) and mitral (24%). Seventy-six percent of affected valves were native, and 24% were prosthetic. Common risk factors included intravenous drug use (48%) and chronic ethanolism (21%). No sustained increase in deaths due to IE was identified. These data show marked differences from clinical literature, including a lower average age and higher incidence of substance use disorders, and it is unlikely selection bias is the sole reason. There was inconsistency in death certification, most notably by not including pertinent IE risk factors. Improving consistency and quality of IE death certification will aid in detecting regional trends and assist multi-institutional collaboration efforts.
{"title":"The Forensic Perspective of Infectious Endocarditis: A Retrospective Study With Recommendations for the Future.","authors":"Alison Krywanczyk, Thomas Gilson","doi":"10.1097/PAF.0000000000000942","DOIUrl":"10.1097/PAF.0000000000000942","url":null,"abstract":"<p><p>Increasing rates of infectious endocarditis (IE) are well-described in the United States and worldwide, yet forensic literature regarding IE is sparse. Autopsy databases may help identify subsets of patients at increased risk of mortality. We reviewed all deaths due to IE in our office between 2010 and 2022 (with full autopsy performed) and found 29. The average age was 44 years. Manners of death included natural (69%), accident (28%), and homicide (3%). For all accidental deaths, acute intoxication was included in either part I or II. The aortic valve was most affected (62%), followed by tricuspid (28%) and mitral (24%). Seventy-six percent of affected valves were native, and 24% were prosthetic. Common risk factors included intravenous drug use (48%) and chronic ethanolism (21%). No sustained increase in deaths due to IE was identified. These data show marked differences from clinical literature, including a lower average age and higher incidence of substance use disorders, and it is unlikely selection bias is the sole reason. There was inconsistency in death certification, most notably by not including pertinent IE risk factors. Improving consistency and quality of IE death certification will aid in detecting regional trends and assist multi-institutional collaboration efforts.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"287-291"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-23DOI: 10.1097/PAF.0000000000000951
Timothy Ogburn, Irfan Chaudhry, Laura D Knight
Abstract: Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.
{"title":"When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice.","authors":"Timothy Ogburn, Irfan Chaudhry, Laura D Knight","doi":"10.1097/PAF.0000000000000951","DOIUrl":"10.1097/PAF.0000000000000951","url":null,"abstract":"<p><strong>Abstract: </strong>Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing \"ethylene glycol\") and THC for \"endometriosis-related pain relief.\" Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"335-339"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-23DOI: 10.1097/PAF.0000000000000950
Kevin W Meyer, Robert J Trager, Clinton J Daniels, Zachary A Cupler
{"title":"Letter to the Editor: Self-Manipulation Inaccurately Associated With the Chiropractic Profession.","authors":"Kevin W Meyer, Robert J Trager, Clinton J Daniels, Zachary A Cupler","doi":"10.1097/PAF.0000000000000950","DOIUrl":"10.1097/PAF.0000000000000950","url":null,"abstract":"","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":"366-367"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}