Black esophagus
- PDF / 1,698,001 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 71 Downloads / 234 Views
IMAGES IN FORENSICS
Black esophagus Michael Tsokos
Accepted: 20 January 2011 / Published online: 6 February 2011 Ó Springer Science+Business Media, LLC 2011
Case report A 64-year-old man with no previous history of disease was found dead in his apartment. Except for sparse post-mortem lividity, external examination of the body (height 1.68 m; weight 117 kg) at the death scene was unremarkable. To clarify the cause of death, a medico-legal autopsy was performed. At autopsy, circumferential black discoloration of the esophageal mucosa that extended along the entire esophagus and ended abruptly at the esophagogastric junction (Figs. 1, 2) was found. Neither ulcerations nor esophageal perforation were present. Within the duodenal mucosa, two fresh ulcers measuring 0.2 and 0.5 cm in diameter were present. In all parts of the gastrointestinal tract considerable amounts of bloody and hematinized fluid were seen. There was marked pallor of all internal organs. Apart from a moderate arteriosclerosis, there were no other pathological findings. The mucosa of the mouth, epi- and hypopharynx did not showed discoloration or any other remarkable findings. Histologically, there was full-thickness necrosis of the esophageal mucosa that was sharply demarcated by a broad zone of neutrophilic granulocytes located in the upper submucosa (Fig. 3). The lower layer of the submucosa and the muscularis propria were unremarkable. No inflammatory cells or any other pathological changes were
M. Tsokos (&) Institute of Legal Medicine and Forensic Sciences, Charite´— Universita¨tsmedizin Berlin, Turmstr. 21 (Haus L), 10559 Berlin, Germany e-mail: [email protected]
123
Fig. 1 Black esophagus in an unfixed autopsy specimen. The entire esophageal mucosa shows a black discoloration
detectable in the adventitia. Neither vasculitis nor microthrombi were detectable in any of the layers of the esophageal wall. The necrosis of the mucosa as well as the underlying pathological alterations located in the upper layer of the submucosa ended abruptly at the transitional line of the esophagogastric junction. The gastric mucosa located in the immediate vicinity of the esophageal lesions was unaffected. There was no light microscopic evidence of viral infection such as cytoplasmic or nuclear inclusions, particularly within the epithelial cells of the esophagus. Grocott staining was negative for mycotic infection. Bacteria were not detectable in the esophageal wall on
Forensic Sci Med Pathol (2011) 7:374–376
375
Discussion
Fig. 2 Closer view of the sharp demarcation of the circumferential black discolouration of the entire esophageal mucosa at the esophagogastric junction
Fig. 3 Histological appearance of black esophagus. Full-thickness necrosis of the esophageal mucosa sharply demarcated by a broad zone of neutrophils located in the upper layer of the submucosa (Hematoxylin-eosin, original magnification 9 25)
Gram staining. Prussian blue staining failed to show any hemosiderin deposits. Toxicological analyses for drugs and ethanol were negative. Death w
Data Loading...
