1/5. Postmortem blood and vitreous humor ethanol concentrations in a victim of a fatal motor vehicle crash.A 20-year-old male was found on the passenger side of a small car after a collision with a semi-trailer truck. Postmortem blood, collected from the chest cavity, and vitreous humor samples were collected following harvesting of the heart and bones. Gas chromatographic analysis revealed a blood ethanol concentration of 0.32 g/dL and a vitreous humor ethanol concentration of 0.09 g/dL. The stomach was intact and full of fluid and food, but its contents were not collected. Possible explanations for the large difference between the two results include diffusion of ethanol from the stomach into the chest cavity, contamination of the blood sample prior to collection, and ingestion of a large quantity of ethanol shortly before death. This case demonstrates the importance of proper quality assurance procedures in collecting postmortem specimens and of collecting a vitreous humor sample for ethanol analysis in postmortem toxicology cases.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/5. Primary cardiac lymphoma--a case report.Primary cardiac lymphoma, which is very rare, is generally regarded to have a poor prognosis. A case of a 69-year-old man with primary cardiac lymphoma diagnosed by antemortem examination is reported. A computed tomography scan of the chest demonstrated a huge right atrial mass with invasion into the other chambers. No mediastinal lymphadenopathy was detected. Cytologic analysis of pericardial effusion revealed diffuse large B-cell type non-Hodgkin malignant lymphoma. The patient died on the 18th day of chemotherapy (cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone) due to low-output syndrome and multiple organ failure. At autopsy, massive gray-white tumor almost occupied the right atrium and invaded the right inferior lobe of the lung. Although prognosis of primary cardiac lymphoma remains poor, early diagnosis may improve the prognosis.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
3/5. Positive personal identity of skeletonized remains using abdominal and pelvic radiographs.Premortem and postmortem radiographs of the chest and abdomen are often available for comparison and provide a basis for making or rejecting an identification. The case reported here exemplifies the way that individualizing features, such as contours of bony elements, skeletal anomalies, and radiodensities and radiolucencies, are used in establishing personal identity.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
4/5. Comparative alcohol concentrations in blood and vitreous fluid with illustrative case studies.The toxicology Bureau of the new mexico Department of health performs drug and alcohol testing on approximately 2800 medical examiner cases each year across the entire state. Although blood is usually the preferred specimen for alcohol analysis, the importance of multiple specimen analysis in alcohol-related death investigation is well understood. Quantitative alcohol determination in a variety of postmortem specimens may provide important interpretive information. In a total of 322 consecutive cases, blood and vitreous alcohol concentrations were compared. No alcohol was detected in either specimen in only 27 of the cases. In the remaining 295 investigations, alcohol was detected in the vitreous fluid, blood, or both. Analysis of the data and presentation of case studies reinforce the need for multiple specimen analysis in alcohol-related death investigation. Postmortem blood and vitreous alcohol concentrations were compared in a series of 295 alcohol-positive cases. The vitreous alcohol concentration (VAC) exceeded the blood alcohol concentration (BAC) in 209 cases (71%). Blood alcohol concentrations exceeded vitreous concentrations in 81 cases (27%), and the concentrations were equivalent in 5 cases (2%). For the purpose of this study, samples that were negative in both specimens were excluded. In casework where the VAC > BAC, linear regression analysis indicated an R2 value of 0.958 (n = 209) and a VAC approximately 16% higher than the BAC. The VAC/BAC ratio was more variable at lower BACs (< 0.1 g/100 mL). The source of blood for this data set was predominantly femoral (n = 203), followed by heart (n = 5) and pleural cavity (n = 1). Although VAC/BAC ratios were more consistent at concentrations of 0.1 g/100 mL and above, the overall ratio ranged from 1.01 to 2.20. Of the 81 cases where BAC > VAC, a total of 24 cases indicated no vitreous alcohol. The range of blood alcohol concentrations among these cases was widely variable (0.01 to 0.30 g/100 mL). Unlike the VAC/BAC data set which consisted of 97% femoral blood, the source of blood in the BAC > VAC data set was slightly more variable. Of the 81 cases where BAC > VAC the blood source consisted of femoral (n = 68), heart (n = 8), pleural cavity (n = 2), carotid (n = 1), jugular (n = 1), and chest blood (n = 1). All analyses were conducted using dual-column gas chromatography with flame-ionization detection (GC-FID) with a reporting limit of 0.01 g/100 mL ethanol in postmortem samples. A series of case studies are used to demonstrate postmortem interpretive issues and the benefits associated with multiple specimen analysis. Cases include postmortem production of ethanol, rapid or unexpected death during the absorptive phase, and site-dependent differences following traumatic injury. Actual case studies involving other volatile organic compounds are also presented including isopropanol and acetone from endogenous and exogenous sources. Many of these cases studies highlight the difficulty associated with postmortem alcohol interpretation in the absence of multiple specimens or adequate case history.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
5/5. Suspected maternal infanticide in a case of hydranencephaly.A medico-legal autopsy case of hydranencephaly in a male infant which was first suspected of maternal infanticide is reported. The infant was 48 cm in height, weighed 2.86 kg and the circumference of the head, the chest and the abdomen was 32.2 cm, 31.0 cm and 30.4 cm, respectively, with no deformities of the head or body. autopsy examination, however, revealed a severe defect in the central nervous system. The cranial cavity was filled with a cloudy dark red fluid (ca. 310 ml) instead of the cerebral hemispheres. The residual central nervous tissues were mostly subtentorial structures from the midbrain to the spinal cord namely, corpus mamillare, corpora quadrigemina, corpus pineale, crus cerebri, pons, cerebellum, medulla oblongata and spinal cord. The basal ganglia, thalamus, hypothalamus and chiasma opticum could not be found, although atrophic hypophysis, eyeballs and optic nerves were present. The usual distribution of cerebral blood vessels, especially the branches of the anterior and middle cerebral arteries and Willis' ring, was absent despite the presence of the internal and external carotid arteries. Other organs were, in general, congestive. The marked cortical atrophy of the adrenal glands (left 0.5 g, right 0.6 g), especially the zona fasciculata, was characteristic. The hydrostatic lung test gave partially positive results, but this was considered to be due to artificial respiration by an ambulance man because amniotic fluid components were microscopically noted and fully expanded alveoli were not found. In conclusion, the cause of the infant's death was diagnosed as stillbirth due to aspiration of amniotic fluid caused by the severe defect of vegetative hypothalamic function through hydranencephaly.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |