PATHOLOGY IMAGE OF THE MONTH: Sudden Cardiac Death Caused by an Uncommon Disease

Area of Science:

• Cardiovascular Pathology
• Forensic Autopsy
• Medical Device Analysis

Background:

• A 57-year-old female was autopsied due to unexplained death.
• An implantable cardioverter-defibrillator (ICD) was present with leads in the right atrium and ventricle.
• Medical history was unknown prior to autopsy.

Purpose of the Study:

• To conduct an unrestricted autopsy to determine the cause of death.
• To document cardiac findings and associated pathologies.
• To investigate the condition of medical devices found during autopsy.

Main Methods:

• Unrestricted autopsy performed under coroner's authorization.
• Gross examination of the heart, including measurements of cardiac chambers and wall thickness.
• Histological examination of myocardial tissue with special stains for microorganisms.

Main Results:

• Enlarged heart (430gm) with left ventricular hypertrophy (1.9cm) and right ventricular dilatation.
• Broad patches of white-yellow myocardial discoloration observed on all cardiac walls and septum.
• Findings also included a vena caval filter, patent foramen ovale, and pulmonary hypertension.

Conclusions:

• The autopsy revealed significant cardiac pathology, including hypertrophy and myocardial discoloration.
• The presence of an ICD and vena caval filter were noted incidental findings.
• Microscopic examination ruled out infectious causes for the myocardial changes.