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Fat embolism syndrome (FES) can be challenging to diagnose by forensic pathologists. For the diagnosis of FES, there is no benchmark test. Postmortem diagnosis requires a full autopsy and specific ancillary examination. However, the high variability in the clinical presentation of FES represents a relevant issue, and there is no consensus on the postmortem assessment. This is the case of a 33-year-old man who died of FES one week after a car accident. He suffered multiple fractures, but was hemodynamically stable and showed no neurological changes. The patient died a few days after hospital discharge. Additionally, he had osteogenesis imperfecta type III, a genetic disorder associated with bone fragility. To the best of our knowledge, no study has assessed whether and how osteogenesis imperfecta contributes to the onset of FES. Despite the heterogeneous manifestations of FES, the present case met many of the proposed clinical and histological diagnostic criteria. Therefore, we briefly review FES diagnostic criteria, show the postmortem diagnostic workup, and discuss the hypothetical link between osteogenesis imperfecta and FES. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac death is a major public health concern. The incidence of sudden cardiac death in young adults remains unclear and is generally underestimated. Case presentation: This is a case report of a 24-year-old man with a silent pathological history, who suddenly collapsed in a restaurant during dinner with his workmates. Autopsy and ancillary examination revealed focal atrioventricular node fibrosis and thymic hyperplasia. Conclusions: Thymic hyperplasia has been considered a cause of sudden death in the past century. The mode of death was explained through nosographic entities such as status lymphaticus or thymic asthma, which are currently consigned to history books. Nevertheless, recent studies have sought to determine the relationship between thymic hyperplasia and sudden unexpected deaths in adults. Moreover, isolated fibrosis of the atrioventricular node is a rare condition that can remain undiagnosed even after a full autopsy. This report aims to provide a concise review of the existing literature concerning sudden cardiac death and discuss the so-called "thymic death" theory, which is now considered a myth. Was the finding of thymic hyperplasia and atrioventricular node fibrosis a coincidence? Should the myth surrounding "thymic death" be re-examined? [ABSTRACT FROM AUTHOR]

Since the beginning of March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been the cause of millions of deaths worldwide. The need to better define the pathogenesis of coronavirus disease 19 (Covid-19) as well as to provide the correct statistical records concerning deaths related to this virus, inevitably involves the role of forensic pathology and routine autopsy practice. Currently, some data on macroscopic and microscopic features in autopsies performed in suspected Covid-19 cases are reported in the literature. The persistence of SARS-CoV-2 in cadavers has not yet been elucidated and only a few reports have emphasized the importance of evaluating the Virus RNA in post-mortem tissues. In this preliminary study, we observed that SARS-CoV-2 survives in multiple cadaver tissues many days after death despite some extreme conditions of post-mortem body preservation. The results of this on-going analysis could help improve the safety of working practices for pathologists as well as understanding the possible interaction between microbiological agents and the cadaver tissue's supravital reactions. [ABSTRACT FROM AUTHOR]

The term overkill usually indicates the infliction of massive injuries by far exceeding the extent necessary to kill the victim. Only few articles or textbooks report this term that is mostly associated with sex-motivated homicides where injuries, generally stabbing, are directed to significant sexual parts of the body. The aim of this study is to shed light on the phenomenon of overkill by reviewing some cases personally analyzed by the authors from both a forensic pathology rather than forensic psychiatry views. The reported results coupled with the literature revision confirmed the importance of a complete analysis of all criminological elements for better defining overkill cases. [ABSTRACT FROM AUTHOR]

A rare case of lethal idiopathic plasmacytic lymphadenopathy ( IPL) with polyclonal hyperimmunoglobulinemia with chronic renal failure is described. A 40-year-old woman who had suffered from upper airways disease was admitted to the Emergency Room with acute renal failure and hypergammaglobulinemia. She developed pericardial effusion, a pruritic rash, splenomegaly and fell into a coma after 6 days. Multiple myeloma, infection, collagenopathy, and coagulopathy were ruled out. Finally, a form of malignant hypergammapathy was suspected. At autopsy, lymph nodes were infiltrated by polyclonal plasma cells and lymphocytes, with erythrophagocytosis features; immunohistochemistry confirmed the plasma cells (CD138+), with a prevalence of kappa-positive cells, B (CD20+) and T (CD3+) cells. Kidneys showed advanced glomerulosclerosis containing similar infiltrates. The cause of death was IPL with polyclonal hypergammaglobulinemia and advanced renal failure. Similar cases are unusual, and possible medical liability associated with failure to diagnose and treat idiopathic plasmacytic lymphadenopathy deserves discussion and further studies. [ABSTRACT FROM AUTHOR]

Myocarditis is an inflammatory disease of myocardium, associated with nonischemic necrosis and degeneration of myocytes. Although the clinical course is rapid, myocarditis can lead to dilated cardiomyopathy with chambers dilatation and ventricular dysfunction. The pathophysiology of myocarditis in humans is not completely understood. There are several etiological agents implicated, mainly viral agents. The clinical presentation is extremely various, with nonspecific systemic symptoms until sudden death. The great variability of symptoms makes the diagnosis, therefore, extremely difficult. We report the case of a 40-year-old woman who developed, after childbirth, hyperthermia associated with neck and left arm pain; initially treated with acetaminophen, without any benefit, the young woman, after few days, died suddenly. The autopsy documented the presence of edematous lungs and enlarged and congested liver. The microbiological tests performed 4 days after death were negative. The heart was normal in shape and volume; a section of the left ventricle wall showed subendocardial discromic areas histologically characterized by multifocal perivascular and interstitial inflammatory infiltrates. These infiltrates consisted mainly of neutrophils with eosinophil component associated with myocyte necrosis and hemorrhagic interstitial infiltration. [ABSTRACT FROM AUTHOR]

• Dog bites are still a major health problem and may cause injuries or even death. • Italian law establishes the responsibility for any dog aggression lies with its owner. • A technical multidisciplinary evaluation of bite marks may help to identify the dogs involved in the attack. Lethal injuries by animal attacks are a matter of concern for the forensic pathologist; the presented case illustrates a two dogs attack on a 61-year-old man. The authors have focused on a multidisciplinary approach involving forensic pathologists and veterinarians. The victim was cycling in the countryside when he was attacked by two dogs that came out of a large house. He was found lying in the street by the homeowners who called for help. The victim was transported to the hospital where he died five days later. According to recovery data and medico-legal autopsy findings the cause of death was septic shock. Forensic pathologists and veterinarians multidisciplinary evaluation revealed lacerations, abrasions, and multiple small punctures constituting bite marks over the entire body. Six skin dowels with bite marks were taken and compared with the dental cast of the dogs. A comparison of the dog dental casts and the bite marks on the victim's body allowed the identification of the animals involved in the attack. [ABSTRACT FROM AUTHOR]