Myocardial infarction in the pediatric age group: forensic autopsy findings and diagnostic challenges

This study represents the first case series from Türkiye to systematically examine autopsy-confirmed myocardial infarction [MI] in the pediatric age group. The aim of the study was to evaluate the demographic, clinical, and pathological features of pediatric MI cases and to identify potential associated factors. All the cases demonstrated histopathological evidence of MI, and MI was identified as the immediate cause of death in 41.7% of cases. Age, sex, scene of discovery, cause of death, body mass index [BMI], heart weight, and histopathological features were analyzed. Half of the cases were male. All cases had patent coronary lumens with no thromboembolic occlusion. Histopathological examination showed features consistent with approximately 24 h in 75.0%, 72 h in 16.7%, and 10-14 days in 8.3% of cases. In cases aged > 24 months, MI-related deaths had higher mean heart weights and BMI than deaths due to other causes within the same age stratum. Although uncommon, pediatric MI can occur in the absence of coronary thrombosis. The findings of this study suggest that pediatric MI is frequently associated with non-atherosclerotic and multifactorial mechanisms. However, these observations are based on a limited forensic autopsy sample and should be interpreted with caution.