Search

On a mid-summer day, a middle-aged man with severe pectus excavatum died unexpectedly in his bed one to two weeks after the onset of dyspnea, which had been followed by bedrest and restricted drinking and eating. Computed tomography (CT) and autopsy demonstrated an eccentrically hypertrophied heart (weight 600 g), which was displaced, rotated, and occupied a large space in the left thoracic cavity due to a deeply depressed sternum. The pulmonary artery was bent and extended across the left thoracic cavity to the right hilum. Anatomical abnormalities in the heart and pulmonary artery obstructed the right ventricular outflow, dilated the right ventricle, and induced restrictive hemodynamics. The left lung was atelectatic due to compression by the heart, while the right lung was enlarged and partly expanded to the left upper thoracic cavity. Histology confirmed pulmonary infarctions at different stages in the upper and middle lobes of the right lung. Restrictive hemodynamics promoted right ventricular dilation, causing spatial limitation of the left thoracic cavity. It is presumed that diastolic right ventricular dysfunction would have rapidly progressed along with pericardial effusion (150 mL), and intra-cardiac thrombi were formed due to stagnation, arrhythmia, bedrest, and dehydration. Consequently, the thrombi would be repetitively embolized in the right lung, thereby aggravating respiratory dysfunction and right-sided heart failure. This is the first autopsy report on the unexpected death of an untreated adult patient of pectus excavatum, with systematic pathophysiological analyses on the basis of the postmortem CT, macroscopic, and microscopic findings.

A middle-aged woman with unrepaired congenital heart disease died suddenly from asphyxia due to hemoptysis. Postmortem computed tomography, autopsy, and histological examinations revealed the presence of an aneurysm and dissection of the right main pulmonary artery with intraluminal thrombus. The observed congenital heart diseases included patent ductus arteriosus, ventricular septal defect, and right-sided aorta. These anomalies predisposed her to left to right shunt, resulting not only in pulmonary artery hypertension and right ventricular hypertrophy, but also pulmonary artery aneurysm and dissection. Histological examinations confirmed the presence of medial degeneration and elastic fiber disruption, as well as muscular hyperplasia of the vasa vasorum and follicular infiltration of the lymphocytes and plasma cells in the main pulmonary artery. These changes may have contributed to the pathogenesis of the aneurysm and dissection through the induction of arterial wall fragility. Histology demonstrated, in addition to findings of pulmonary hypertension, such as plexiform lesions, medial-intimal hyperplasia, and veno-occlusive lesion, unique findings related to multiple dissections of the intra-pulmonary elastic arteries, which may have caused the lethal hemoptysis.

Introduction: Arachnoid cyst, a congenital extra-axial lesion, has been implicated in osteolytic lesion and subdural hematoma. Cerebral venous thrombosis occasionally induces subdural hematoma. Case report: A man in his mid-forties with congenital bone defects was found dead after recumbency for months. Autopsy disclosed acute subdural hemorrhage and intracranial hemorrhage that infiltrated to the right neck through large occipital bone defects. CT demonstrateda high density area in the supratentorial venous sinuses and an infratentorial low-density mass adjacent to the bone defects, suggesting cerebral venous thrombosis and arachnoid cysts, respectively. Conclusion: This is the first report on death due to nontraumatic extracranial and subdural hemorrhage derived from cerebral venous sinuses and possibly associated with arachnoid cysts and cerebral venous thrombosis.