Medico-Legal Aspects of Pulmonary Thromboembolism

Margiotta, Gabriele; Coletti, A.; Severini, Simona; Tommolini, Federica; Lancia, Massimo

doi:10.1007/5584_2016_130

Cited by 11 publications

(8 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Secondly, we evaluated the inflammatory infiltrate and the evolution of the fibrotic state from 1th to 72th hour. In forensic practice, PE is one of the major causes of SUD [13, 15, 16]. The accuracy of ante-mortem diagnosis is within the range of just 10–30% [17], representing one of the most frequent missed diagnosis in SUD.…”

Section: Discussionmentioning

confidence: 99%

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Mansueto

Costa

Capasso

et al. 2019

BMC Cardiovasc Disord

View full text Add to dashboard Cite

BackgroundPulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time.MethodsPulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values.ResultsThe 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h.ConclusionsAfter a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death.Clinical trial numberNCT03887819.Trial registrationThe trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was “Retrospectively registered”.

show abstract

Section: Discussionmentioning

confidence: 99%

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

Mansueto

Costa

Capasso

et al. 2019

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Various diseases, including cancer, in ammatory disorders, and infection, are deemed to be responsible for the formation of thrombi. In addition, the use of female hormones, pregnancy, and puerperium increase the risk of thrombogenesis [1,2,6]. Traditionally, blood stasis, hypercoagulable state, and vascular endothelial damage are considered the main reasons for thrombosis [3].…”

Section: Discussionmentioning

confidence: 99%

“…PTE is a complex multifactorial disease for which many genetic and acquired risk factors have been identi ed [1,2,6,8,9]. Among the main risk factors, surgery and extended hospital admission are considered closely related.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary thromboembolism (PTE), which refers to pulmonary circulation disorder and cardiac dysfunction caused by deep vein thrombosis (DVT) occluding blood vessels of the pulmonary arterial tree [1], is the third leading cause of death from cardiovascular disease [2]. Epidemiological studies show that the mortality rate in untreated PTE patients is as high as 30-35%, and more than 10% of inpatient deaths are related to pulmonary embolism [3,4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Chen¹,

Wang²,

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…U analiziranom materijalu nešto više od polovine pacijenata su bili muškarci (52/90; 58%). Prosečna starost pacijenata je bila 71±14,1 godina (15)(16)(17)(18)(19)(20)(21). Žene su statistički bile značajno starije od muškaraca (t-test; p=0,024).…”

Section: Rezultatiunclassified

Cause of death during the first 24 hours after hospitalization: An autopsy study

Janković¹,

Jordanova²,

Jevtić³

et al. 2020

Halo 194

View full text Add to dashboard Cite

Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.

show abstract

Medico-Legal Aspects of Pulmonary Thromboembolism

Cited by 11 publications

References 33 publications

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study

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

Cause of death during the first 24 hours after hospitalization: An autopsy study

Contact Info

Product

Resources

About