Post-mortem CT with macroscopic and microscopic correlation in a case of sudden death due to systemic sarcoidosis
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Post-mortem CT with macroscopic and microscopic correlation in a case of sudden death due to systemic sarcoidosis Jatin Bodwal 1,2 & Marc Napoleone 3 & Jayantha Herath 2 Accepted: 8 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We report a case of sudden death due to systemic sarcoidosis in a fifty-four year old male who was reportedly healthy. A computerized tomography (CT) scan was performed before the autopsy. It showed cardiomegaly with hilar and abdominal lymphadenopathy. The autopsy showed pale yellow plaque deposition on the heart surface which was infiltrating the myocardium. Histological examination of the heart, lungs, liver, and spleen showed extensive sarcoid granulomata which helped in establishing the cause of death. Keywords Sarcoidosis . Post-mortem CT . Sudden death
Case report A man in his mid-fifties was found dead in the bed at his residence by his landlord. The deceased had been living at his friend’s house for the past 3 years and was reportedly healthy over the last few days to months prior to his death. He had a past medical history of hypertension, elevated cholesterol, and elevated prostatic surface antigen (PSA). There was no history of drug and alcohol abuse and his family history was not known. Medications included only hypolipidemic and anti-hypertensive drugs. The deceased’s body underwent a routine pre-autopsy CT and a post-mortem examination. CT images revealed an enlarged heart with bilateral symmetric hilar and right paratracheal lymphadenopathy in the thoracic region (Figs. 1 * Jatin Bodwal [email protected] 1
Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Saheed Mangal Pandey Marg, Nanak Pura, Hari Nagar, New Delhi 110064, India
2
Department of Pathobiology and Laboratory Medicine, University of Toronto & Ontario Forensic Pathology Service, Toronto, Ontario, Canada
3
Department of Diagnostic Radiology, University of Toronto, Toronto, Ontario, Canada
and 2). In the abdominal region lymph nodes in the porta hepatis and para-aortic regions were also enlarged (Fig. 3). CT images raised our suspicion towards the diagnosis of sarcoidosis. On external examination no significant findings were observed. At autopsy, the heart weight was enlarged and hypertrophied (560 g) with mild remodeling. Pale/yellow to white, plaque-like diffuse infiltrative disease was identified in the myocardium (Fig. 4a and b). The infiltrative process was diffusely present throughout the myocardium, involving the full thickness of all four chambers, extending to the ascending aorta and valves. These plaques predominantly involved the myocardium of the left ventricular free wall, followed by the septum, right ventricle, and atria. The myocardial wall thickness of the left ventricle and interventricular septum was 1.7 cm and the wall thickness of the right ventricle was 0.5 cm. Histological examination of the heart showed numerous non-necrotizing granulomata resembling the microscopic features of sarcoid granuloma associated wit
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