Heart of glass: fatal hematemesis caused by bronchiole-cardiac fistula
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Heart of glass: fatal hematemesis caused by bronchiole‑cardiac fistula Maggie Bellis1,2 · Kristopher S. Cunningham1,2 · Michael J. Pickup1,2 Accepted: 24 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A 58-year old woman presented for autopsy after having been found unresponsive in a public bathroom surrounded by a pool of blood. During attempts at resuscitation, blood was noted in her airway. She had a past medical history that included surgical repair of Tetralogy of Fallot as a child. At autopsy, a shard of glass was identified projecting from the surface of the left lung, having formed densely fibrotic adhesions at the pleural surface. The glass also penetrated through a bronchiole lumen and into a previously surgically repaired bulging right ventricular outflow tract, forming a bronchiole-cardiac fistula, allowing for the massive hemoptysis that led to her death. After further inquiry, it was discovered that the decedent also had a history of seizure disorder and had fallen through a glass door during a seizure many years ago, requiring several shards of glass to be removed from her chest wall. Keywords Forensic pathology · Autopsy · Hematemesis · Fistula · Bronchiole-cardiac fistula
Case report A 58-year-old woman was having lunch with her husband in a restaurant when she stated that she did not feel well and went to the restroom. When she did not return after some time, her husband went to check on her and found her collapsed on the bathroom floor surrounded by a pool of bright red blood. When paramedics intubated her, they remarked that there was blood in her airway. She was taken to hospital, where resuscitation attempts were unsuccessful, and death was pronounced. The husband informed the Coroner that one week prior she had an episode of vomiting blood. She had a past medical history of hypertension, congenital heart disease requiring two corrective surgeries in childhood and a stroke resulting in paralysis and contractures of her left arm. The body came to the Provincial Unit of the Ontario Forensic Pathology Service in Toronto, Ontario Canada for autopsy, where we have the benefit of dedicated postmortem imaging. Upon review of the decedent’s full body * Maggie Bellis [email protected] 1
Ontario Forensic Pathology Service, 25 Morton Shulman Avenue, Toronto, Ontario M3M 0B1, Canada
Department of Laboratory Medicine and Pathobiology, University of Toronto, I King’s College Circle, Toronto, Ontario M5S 1A8, Canada
2
postmortem CT scan (PMCT), a triangular-shaped foreign object was identified projecting from the left lung into what appeared to be a large right ventricular outflow tract (Fig. 1). On external examination, the decedent was of short stature 154 cm (5’1/2) and 68.5 kg (151 lbs.) and the skin was pale. There were numerous scars on the upper limbs and torso. The left hand and wrist were atrophic and contracted in keeping with the history of stroke. There were slightly dysmorphic facial features, raising the qu
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