Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner's Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests.

Clots and thrombi identified at autopsy are generally classified dichotomously as antemortem or postmortem. Current articles and textbooks support this approach. Earlier literature often contained descriptions of a third category, the agonal thrombus that forms while the patient is dying. We collected 238 autopsy cases including 80 rapid/sudden deaths by violence and 21 (including 1 pediatric) deaths from acute pulmonary emboli. We analyzed the gross and microscopic features of clots and thrombi. Agonal thrombi were identified in 122 cases (89% of cases of "slow" death). Agonal thrombi were not identified in cases of sudden death. We found that a comprehensive description of the macroscopic features was a key to interpretation. The gross and microscopic features of agonal thrombi "chicken fat" support their hybrid nature. The dichotomous classification of clots and thrombi seems to be founded on assumptions of clinical significance but is perhaps oversimplified. Agonal thrombi area distinct class of thrombus that, although not clinically significant as an immediate cause of death, arises by its own mechanisms and has its own morphology. It is advisable to avoid classifying agonal thrombi as mere postmortem clots because in forensic cases, they may help support an argument against sudden death.

Contrary to claims that the autopsy has not significantly changed over the past 150 years, this article will demonstrate the remarkable evolution of the autopsy at the hands of its practitioners since the 15th century and into the 21st. A solid understanding of the ongoing evolution of autopsy technique helps provide a firm argument for the continued utilization of the autopsy in daily practice and for the advancement of medicine.

Liver cysts are commonly found incidentally from imaging scans or at autopsy. These benign neoplasms vary in size and represent a heterogeneous group of disorders, for which the demographics, risk factors, apparent inciting event, clinical presentation, and outcome are varied. Complications that can develop from a liver cyst include development of spontaneous hemorrhage, infection, and/or obstruction. Although the etiology of liver cysts varies, fatal rupture of a hemorrhagic liver cyst due to anabolic steroid use is a rare occurrence. In fact, there are few reported cases in journal literature. We report a case of a fatal liver cyst rupture with resultant hemoperitoneum in the presence of anabolic steroid (stanozolol) use.