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Asphyxia by tracheobronchial thrombus.

Kim A Collins1, S Erin Presnell

  • 1Department of Pathology and Laboratory Medicine, Forensic and Autopsy Pathology, Medical University of South Carolina, Charleston, 29425, USA. collinsk@musc.edu

The American Journal of Forensic Medicine and Pathology
|November 24, 2005
PubMed
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Sudden airway obstruction by tracheobronchial thrombi caused asphyxia and death in two women with metastatic adenocarcinoma. This rare cause of death highlights the importance of considering unusual etiologies in respiratory distress cases.

Area of Science:

  • Forensic Pathology
  • Pulmonology
  • Oncology

Background:

  • Airway obstruction leading to asphyxia has diverse causes, ranging from chronic conditions like neoplasms to acute events such as infections or aspirations.
  • Acute airway obstruction can be sudden and may not be immediately apparent to clinicians or investigators.
  • Metastatic adenocarcinoma is a common malignancy, but its association with tracheobronchial thrombus formation is exceptionally rare.

Observation:

  • Two cases are presented: a 43-year-old female with metastatic breast adenocarcinoma and a 78-year-old female with adenocarcinoma of unknown primary.
  • Both patients experienced sudden respiratory distress and airway obstruction.
  • Autopsies revealed large tracheobronchial thrombi causing complete obstruction, leading to asphyxia and death.

Findings:

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  • Microscopic examination of the thrombi showed compositions of fibrin, red blood cells, mucus, and platelets.
  • The 43-year-old patient also exhibited findings of acute respiratory distress syndrome with hyaline membranes.
  • Causes of death were determined to be acute respiratory distress syndrome with tracheobronchial thrombus and asphyxia secondary to airway obstruction by thrombus, respectively.

Implications:

  • These cases highlight tracheobronchial thrombus as a rare but fatal cause of asphyxia, particularly in patients with advanced metastatic cancer.
  • The findings underscore the need for a broad differential diagnosis in cases of sudden respiratory failure and airway obstruction.
  • Further literature review is warranted to understand the specific mechanisms and risk factors contributing to airway thrombus formation in oncologic patients.