The autopsy and diagnosis of pulmonary thrombo-embolism

Micallef, Milton

doi:10.1007/s12024-018-9950-5

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…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

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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”.

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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

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“…Another diagnosis that might be missed AM is pulmonary embolism [ 5 ]. The symptoms may be misinterpreted as primarily cardiogenic, and embolism can be missed despite using computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

When is a postmortem examination carried out? A retrospective analysis of all Swedish deaths 1999–2018

Tamsen

Alafuzoff

2022

Virchows Arch

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The objective of this study was to assess who is merited an autopsy in Sweden. Data from the Swedish cause of death (COD) registry over a period of 20 years was retrieved and analysed. A multinominal logistic regression analysis was performed to identify the variables that were most strongly associated with the performance of a clinical or forensic autopsy (CA/FA).A definite COD, i.e. a COD based on autopsy findings, was registered in 12.6% of all deceased during the investigated period. In the remaining cases, the COD was presumed by the clinicians. Being male, born in the Nordic region, dying in a private residence, and unnatural death were most strongly associated with the performance of CA/FA. In contrast, being female, dying from dementia, dying at a nursing home, being born outside of Europe, or living in a small city or rural area seldom led to the performance of CA/FA.The above is certainly surprising as an autopsy provides an opportunity to investigate the cause of death, validate clinical diagnoses, detect unexpected aberrations, audit health care, and provide feedback to clinicians to facilitate their continuing education.

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“…Over the last 10 years, PMMR has been introduced as an additional tool in post-mortem imaging mainly feasible for diagnosis of soft tissue and organ pathology [5,6]. Acute PTE is a frequently found natural cause of death at autopsy [7]. However, pulmonary infarction accompanying PTE is a less common finding.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of pulmonary infarction in post-mortem computed tomography and post-mortem magnetic resonance imaging—a technical note

et al. 2020

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Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease.Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1 and T2 weighted sequences.

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The autopsy and diagnosis of pulmonary thrombo-embolism

Cited by 8 publications

References 19 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

When is a postmortem examination carried out? A retrospective analysis of all Swedish deaths 1999–2018

Diagnosis of pulmonary infarction in post-mortem computed tomography and post-mortem magnetic resonance imaging—a technical note

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