American Journal of Forensic Medicine and Pathology最新文献

An 18-month-old toddler was found unresponsive in a face-down position by her adoptive mother's boyfriend. The patient had a history of dual airway obstruction: laryngomalacia involving the supraglottic region and a GLUT1-positive infantile hemangioma causing subglottic narrowing. She initially underwent supraglottoplasty, but due to limited improvement and persistent subglottic stenosis, a tracheostomy was performed. She was also prescribed oral propranolol for the hemangioma. At the time of death, the tracheostomy tube was found outside her airway. Whether the tube was removed or dislodged remains unclear, but the loss of airway access caused death. This case highlights the danger of pediatric airway obstruction and the importance of tracheostomy management, airway monitoring, and interdisciplinary care in complex pediatric cases.

Maternal mortality, a global concern, is mitigated by the accurate determination of the cause of death. Maternal death autopsies in our institution fall under pathology, except those under forensic medicine due to medicolegal implications. This study compares provisional (PCOD) and final (FCOD) causes of death in maternal autopsies, driven by queries from clinicians during Maternal Death Review meetings regarding discrepancies between the two. This retrospective study analyzed 92 maternal death autopsies with discrepancies between PCOD and FCOD, over a 6-year period at a tertiary care hospital. Discrepancies were classified into major and minor for organ-specific diagnoses. The commonest encountered pathologies were assessed for true positives, false positives, and false negatives. Major and minor discrepancies were categorized for direct and indirect causes of maternal death. Analysis of 137 diagnoses in these 92 maternal deaths showed the lung was the most common site of discrepancy (78% were major), followed by the brain, liver, kidney, and heart. Acute respiratory distress syndrome (ARDS) and bronchopneumonia caused significant maternal death; 75% of ARDS cases had major discrepancies, mostly due to misdiagnosis as intrapulmonary hemorrhage or bronchopneumonia on gross examination. Discrepancies between gross and histopathologic findings reflect unavoidable diagnostic challenges due to inherent limitations of gross pathology, particularly with overlapping appearances.

We recently investigated a death involving a drowning victim found in a slow-flowing part of a river with the right hand clutching a branch of bamboo growing along the bank. Such hand findings have traditionally been ascribed to cadaveric spasm, supposedly representing a stiffening of the muscles that occurs immediately after death. However, another persuasive opinion is that cadaveric spasm is a myth. A rational explanation for our case might thus be that the hand became flaccid immediately after death, but the bamboo branch remained close to the fingers under slow flow, and the subsequent onset of rigor mortis caused the hand to "grasp" the bamboo branch. However, another report of a drowning case described a blade of grass clutched in a hand despite a strong flow in an irrigation canal, which had swept the deceased 5.5 km downstream and stripped off all clothing. That case was difficult to explain without cadaveric spasm, and 2 animal studies have also shown the development of rigor mortis in a small proportion of animals immediately after death. We thus believe that cadaveric spasm deserves further consideration and should not yet be ruled out.

Homelessness remains a critical public health challenge that significantly increases the risk of premature mortality. Data from the Washington, D.C. Office of the Chief Medical Examiner were used to examine the mortality rates among undomiciled individuals between 2019 and 2023. This study focused on understanding how factors such as location, submanner of death, and decedent history contribute to overall mortality risk. Our analysis reveals that the Washington, D.C. mortality trends are consistent with observations in larger metropolitan areas and counties. The year 2020 emerged as the period with the highest mortality rate, and the rates demonstrated considerable fluctuations over the study period. In total, 712 deaths were recorded, predominantly among males and African Americans, with an average age of 49.4 years. Notably, intoxication-related fatalities accounted for 57.7% of deaths, with fentanyl being the most common contributing substance. In addition, a significant proportion of decedents had chronic health conditions or a history of substance use, underscoring complex underlying vulnerabilities. These findings highlight the necessity for enhanced mortality surveillance utilizing data from medical examiners and coroner offices to inform and refine public health initiatives and social programs aimed at mitigating preventable deaths among the undomiciled population.

The Fourth Industrial Revolution has accelerated the integration of robotics and artificial intelligence (AI) into workplaces, creating opportunities to merge technology with real-world practice. In forensic pathology, workforce shortages and the dangers of investigating hazardous death scenes highlight the need for innovation. This study explored the use of a mobile, agile quadruped robot to investigate hanging death scenes, assessing its ability to navigate, capture evidence, and reduce human risk. The research focused on low-risk hanging death scenes as a starting point, with the aim of later extending to more hazardous environments such as chemical-related scenes, fire deaths, and mass disasters. The quadruped robot demonstrated advanced mobility, allowing routine inspection tasks and the collection of visual and environmental data with accuracy, safety, and frequency. The study reviewed existing literature on robotic applications in forensic investigations, developed an initial procedure for scene evaluation, and tested the approach on selected hanging cases. The findings discuss advantages, limitations, and lessons learned, offering insight into the potential role of robotics in forensic death scene work. While promising, technical and operational challenges remain before robotics can be fully integrated into routine forensic practice.

Individuals who die suddenly and unexpectedly will often fall under the jurisdiction of a Medical Examiner or Coroner (MEC). Forensic pathologists may therefore be the first physicians to diagnose a genetic disease. Identifying these conditions at autopsy improves the accuracy of death certification and provides biological relatives the opportunity to seek diagnosis and intervention. Accessibility and diagnostic capabilities of postmortem genetic testing (PMGT) have rapidly expanded over the last decade since the previous National Association of Medical Examiners position paper on this topic. In this updated position paper, we review the different types of PMGT and the genetic conditions most likely to be encountered at forensic autopsy. Guidelines are also provided for the implementation of PMGT in an MEC office and for the reporting of results.

Compressed-air guns-devices that remove particles such as dust or wood/metal shavings using compressed air-are now widely used in industry. Although rare, the high-speed airflow they generate can cause injuries. A healthy 26-year-old man presented to our emergency department with swelling around his right eye and headache. His history revealed that the injury occurred during routine use of a compressed-air gun while cleaning work clothes. The blast of compressed air to his face resulted in subcutaneous emphysema, orbital emphysema, and pneumocephalus. No obvious entry site for the air could be identified, and no skull, facial, or orbital fractures were present. Compressed-air gun injuries can therefore cause orbital and periorbital emphysema and pneumocephalus, even in the absence of any skull or facial bone fractures detected on routine radiologic examinations or obvious conjunctival tears on ophthalmological examination. The route of air entry into these compartments may be transorbital, transnasal, or transoral, but the precise trajectory remains challenging to determine.