Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism: a Retrospective Study Based on 145 Cases

Abstract

Pulmonary thromboembolism (PTE) is a common cause of sudden unexpected death in forensic practice following deep vein thrombosis (DVT). It remains easy to overlook the special procedure used for the detection of PTE during autopsies; therefore, the relationship between PTE and the associated risk factors is in need of analysis. In the present study, 145 fatal cases of PTE found during autopsies performed from 2004 to 2019 at the Center of Forensic Investigation of China Medical University were retrospectively evaluated; the demographic data, risk factors, original location of DVT, and time interval from the formation of DVT to PTE were analyzed. In addition, the difference in lung-to-heart weight ratio between the PTE and disease-free accident groups was calculated with matching for gender and age. The 40–59 age group accounted for more than half of the total cases (51.03%). Immobilization, trauma or fracture (especially of the pelvis, femur, tibia, or fibula), surgery, pregnancy and cesarean section, mental disorders and the use of antipsychotics were the top 5 high-risk factors for fatal PTE. Among the victims, 92.9% (130/140) died within 60 days of the first exposure to risk factors. Most DVT were formed and shed in lower limb veins, especially popliteal veins and their branches, which caused 87.6% of the thrombi distributed in bilateral pulmonary arteries. No significant difference in the lung-to-heart weight ratio was found between the PTE and control groups. The present study provides valuable information for the prevention and treatment of thrombosis during clinical events and may also be important for alerting forensic examiners to conduct special PTE detection in cases with potential risk factors.