An Update on Myocarditis in Forensic Pathology.

Area of Science:

• Forensic Medicine
• Pathology
• Cardiology

Background:

• Myocarditis presents diagnostic challenges in forensic medicine, particularly concerning sudden death and medical malpractice.
• Accurate evaluation requires comprehensive knowledge of etiopathology, histopathology, and existing literature.
• Histomorphological data on myocarditis have historically been scarce and poorly documented, complicating death investigations.

Purpose of the Study:

• To review the literature on myocarditis in forensic contexts, highlighting diagnostic difficulties.
• To emphasize the need for improved histopathological documentation and etiological identification in myocarditis cases.
• To propose essential elements for a comprehensive understanding and diagnosis of myocarditis.

Main Methods:

• Literature review focusing on etiopathology, histopathology, and diagnosis of myocarditis in forensic medicine.
• Analysis of diagnostic challenges, including the impact of co-infections and deductive reasoning.
• Inclusion of histological images from scientific references to illustrate key aspects.

Main Results:

• The diagnosis of myocarditis as a cause of death is often difficult, leading to potential errors.
• Histopathological data improved post-COVID-19, but autopsy practices and pathogen identification remain areas for improvement.
• Four key areas are identified for better diagnosis: clinical classification, etiological classification, pathophysiology, and histopathological diagnosis.

Conclusions:

• Accurate diagnosis of myocarditis in forensic cases requires robust clinical, etiological, and histopathological data.
• Standardized autopsy practices and precise identification of myocarditis histotypes and causative agents are essential.
• Enhanced understanding of viral/bacterial infections and host responses is critical for forensic pathology.