Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

An Autopsy Report of Hypoplastic Coronary Artery Disease Incidentally Identified in a Young Man

Hypoplastic coronary artery disease (HCAD) is a rare congenital abnormality characterized by underdevelopment of one or more major branches of the coronary arteries, which may lead to myocardial infarction and sudden death. We report a case of HCAD that was incidentally detected during autopsy in a 25-year-old male soldier who died during underwater escape training. On macroscopic examination, the right coronary artery measured 1 mm in diameter, which was significantly smaller than that of other coronary arteries. We observed no anomalies in addition to HCAD. Death was attributed to drowning, which was consistent with autopsy findings and the circumstances of death. Although extremely rare, if sudden cardiac death is suspected in children and young adults, it must be confirmed through careful evaluation.

Cause of Death in Patients in Radiation Oncology

BackgroundThe accurate attribution of death in oncologic patients is a difficult task. The patient’s death is often attributed to his or her underlying cancer and therefore judged as cancer-related. We hypothesized that even though our patient’s cancers were either advanced or metastatic, not all patients had died simply because of their cancer.MethodsA total of 105 patients were included in this retrospective analysis. Patient data were collected from digital and paper-based records. Cause of death was assessed from death certificate and compared to the medical autopsy reports. Discrepancies between premortem and postmortem diagnoses were classified as class I and II discrepancies.ResultsOf 105 patients included, autopsy consent was obtained in 56 cases (53%). Among them, 32 of 56 were palliatively sedated, and 42/56 patients died cancer-related as confirmed by autopsy. The most common cause of death by autopsy report was multiorgan failure followed by a combination of tumor and infection, predominantly lung cancer with pneumonia. Here, 21/56 cases (37%) showed major missed diagnoses: seven cases showed class I, 10 class II, and both discrepancies. The most commonly missed diagnoses in both categories were infections, again mainly pneumonia.ConclusionsCancer was the leading cause of death in our study population. A quarter of the patients, however, did not die due to their advanced or metastatic cancers but of potentially curable causes. We therefore conclude that it is important to consider competing causes of death when treating palliative cancer patients. In a palliative setting, the treatment of a potentially curable complication should be discussed with the patients and their families in a shared decision-making process. From our experience, many patients will decline treatment or even further diagnostics when given the option of best supportive care.

A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report

Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum β-lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.

Demographic and autopsy characteristics of drowning deaths in a major autopsy center of Gandaki province of Nepal

Background: Autopsy examination is mandatory in all unnatural deaths as per law of Nepal and thus all deaths due to drowning are undergone medico legal autopsy. This study aims to analyze the demographic and autopsy characteristics of drowning deaths in cases brought for medico legal autopsy at a major autopsy center of Gandaki province of Nepal. Methods: This study was conducted based on review of database in a period of two years among 53 corpses of drowning related deaths. The demographic data and relevant information from the inquest and autopsy report of such cases were collected and presented. Result: The commonest age group involved in drowning deaths was <20 years, attributing to 22 (41.5%) cases, and with males (41, 77.4%) more common than females. Suicidal drowning (34, 64.2%) was the commonest manner. Maximum (19, 35.8%) deaths occurred in the rainy season and on lakes (34, 64.1%). Conclusion: Drowning deaths were more common among males of young age groups. Most of the drownings occurred during the rainy season, lakes were the common sites of drowning, and the commonest manner was suicidal.