We present here a brief literature review and a case study of postpartum pulmonary arterial hypertension, a rare and progressive disease with a high maternal mortality rate. The patient, a 32-year-old woman, presented with dyspnea and shivering immediately following an uncomplicated vaginal delivery. The patient had no remarkable individual or familial history. She died 4 hours after her delivery, and an autopsy revealed atherosclerosis of the main pulmonary arteries and characteristic plexiform lesions on the lung. The remaining organs showed no remarkable pathology. We reported pulmonary arterial hypertension associated with pregnancy as the cause of death.
Adult ; Atherosclerosis ; Autopsy ; Cause of Death ; Death, Sudden ; Dyspnea ; Female ; Humans ; Hypertension* ; Lung ; Maternal Mortality ; Pathology ; Postpartum Period* ; Pregnancy ; Pulmonary Artery ; Shivering

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

Asphyxia due to plastic bag is not common. The manner of death may be accidental, suicidal or homicidal. We report an asphyxial death using plastic bag, giving us difficulty in determining the manner of death, suicidal or homicidal. A 32-year-old female was found dead in bathroom and her head was wrapped in a supermarket shopping bag sealed with adhesive tape around the neck. Strangely she was handcuffed behind the back of the victim. Because of no evidence of violence on the body and the presence of a suicide note at the scene, the manner of death was concluded as suicide. This case emphasizes that the interpretation of postmortem examination should be incorporated with the proper investigation of circumstances at the scene of death to determine the manner of death.
Adhesives ; Adult ; Asphyxia ; Autopsy ; Female ; Head ; Humans ; Neck ; Plastics ; Suicide ; Violence

The incidence of sudden death due to undiagnosed primary intracranial tumor is very low in forensic autopsy practice. The ganglioglioma is a well differentiated, slow growing primary brain tumor that is encountered predominantly in childhood. We report a sudden, unexpected death in a 6-year-old girl from a ganglioglioma. On autopsy, there was an intraventricular tumor with recent hemorrhage, occupying the anterior aspect of the lateral ventricle and resulting in hydrocephalus. Acute intratumoral hemorrhage appears to be the mechanism of sudden death.
Autopsy ; Brain Neoplasms ; Child ; Death, Sudden ; Ganglioglioma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Lateral Ventricles

Sudden manhood death syndrome (SMDS) is a disorder found in southeast Asia, particularly Thailand, Philippines and Japan, which causes sudden cardiac death during sleep. In Korea, SMDS cases have been occasionally encountered in forensic autopsy practice. However, the incidence and pathogenesis has been rarely studied. This study to review chronologically the proposed pathogenesis of SMDS; pathology of cardiac conduction system, sleeping and breathing disorder, K+ and thiamine deficiency, mental stress, testosterone, hyperlipidemia, and narrow circumference of coronary artery. Brugada syndrome and SMDS are phenotypically, genetically and functionally the same disorder and Brugada syndrome has been a subject of intensive study since its early description in 1992. While Brugada syndrome is an inherited cardiac disorder caused by mutations in the SCN5A gene encoding the cardiac sodium channel alpha-subunit. less than 20% of its patients are known to be associated with SCN5A mutations. Moreover, the postmortem molecular screening of SCN5A mutations on formalin fixed paraffin embbeded cardiac tissues from SMDS cases has not been rewarding due to technical problems. The role of structural heart disease and sodium channel dysfunction in the induction of electrical instability in SMDS and Brugada syndrome is still debatable.
Asia, Southeastern ; Autopsy ; Brugada Syndrome ; Coronary Vessels ; Death, Sudden, Cardiac ; Formaldehyde ; Heart Diseases ; Humans ; Hyperlipidemias ; Incidence ; Japan ; Korea ; Mass Screening ; Paraffin ; Philippines ; Respiration ; Reward ; Sodium Channels ; Testosterone ; Thailand ; Thiamine Deficiency

Vibrio vulnificus primary septicemia is a serious illness associated with high mortality rates and is caused by the ingestion of raw or undercooked shellfish. Most patients admitted with V. vulnificus infection are immunocompromised or have an underlying disease, such as liver cirrhosis or hemochromatosis. In contrast, the authors experienced an uncommon case in which a patient with no known underlying disease rapidly progressed to sepsis with hypotensive shock, followed by death within a few hours. Based on a postmortem examination, tissue cultures, and blood cultures, it was determined that the patient had been infected with V. vulnificus and had chronic liver disease. There are no reports in Korea on the clinicopathological findings of V. vulnificus infection. Here, we present the case of a patient with V. vulnificus septicemia and describe the associated clinical symptoms and clinicopathological findings discovered upon autopsy.
Autopsy ; Eating ; Hemochromatosis ; Humans ; Korea ; Liver Cirrhosis ; Liver Diseases ; Sepsis ; Shellfish ; Shock ; Vibrio ; Vibrio vulnificus

BACKGROUND/AIMS: Sudden cardiac death (SCD), mostly related to myocardial infarction is a common cause of death on forensic autopsy. It is known that the morphologic evidence can not be detected in the early stage of myocardial infarction. Cardiac troponin T (cTnT) is a specific marker of myocardial damage, which is clinically used for the diagnosis of ischemic heart disease with rapid test kit. This study was aimed to evaluate the usefulness of rapid test kit for cTnT in postmortem diagnosis of sudden cardiac death. METHODS: We performed the test on heart blood during autopsy on SCD (n=35) and control (n=10, 5 trauma-related and 5 non-trauma-related) groups, using TROPT(R) sensitive assay kit. RESULTS: 68.6% of SCD was positive, compared with 20.0% of control. There was a statistically significant difference between two groups. Among non-traumatic control, drug intoxication and asphyxia due to O2 deficiency were positive, while all trauma-related cases were negative. 76.2% of SCD within PMI 24 hours was positive, compared with 57.1% after PMI 24 hours. Negative results among SCD were found in the cases died very shortly after the event, with acute change in atheromatous plaque of coronary atherosclerosis. CONCLUSIONS: This rapid test for cTnT could be an adjuvant tool of postmortem diagnosis of SCD. However, the result of this test should be interpreted with caution, considering the duration of the event in SCD and the false positivity on non-traumatic cause of death.
Asphyxia ; Autopsy ; Cause of Death ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Drug and Narcotic Control ; Heart ; Myocardial Infarction ; Myocardial Ischemia ; Troponin ; Troponin T

Since patients with intracranial neoplasms usually represent their neurological symptoms rather early in the course of the disease, sudden unexpected death due to intracranial neoplasms is an uncommon event seen only exceptionally in medicolegal autopsy practice. Although meningiom is one of the most common primary intracranial neoplasms, sudden death due to the tumor is an uncommon event. We report a sudden, unexpected death of a 56-year-old female with an undiagnosed olfactory groove meningioma. It is assumed that peritumoral edema is related to the sudden death among the several mechanisms.
Female ; Humans

Congenital pneumonia is defined as pneumonia acquired transplacentally or perinatally. It is frequently associated with prolonged rupture of the membranes, chorioamnionitis, prolonged labor, premature labor, fetal distress, prematurity and meconium staining. It is one of the important causes of neonatal death. We report a case of congenital pneumonia of a full-term, female neonate who was born by cesarian section and died at 10th hours of her life. There were no maternal signs and symptoms of infection and amniotic fluid was not stained with meconium at birth. We insist that full physical examination and routine laboratory examinations including simple chest X ray are required even in grossly normal neonate without specific risk factors and that possibility of neonatal pneumonia should always be considered when the cause of death cannot be explained immediately by gross autopsy findings.
Amniotic Fluid ; Autopsy ; Cause of Death ; Chorioamnionitis ; Death, Sudden* ; Female ; Fetal Distress ; Humans ; Infant, Newborn ; Meconium ; Membranes ; Obstetric Labor, Premature ; Parturition* ; Physical Examination ; Pneumonia* ; Pregnancy ; Risk Factors ; Rupture ; Sudden Infant Death ; Thorax

Transsexualism is a variety and complexity of conditions to the desire for sex change and may require medical treatments over psychological evaluations in some patients. Consequently, there is a potential confusion in the determination of anatomical sex in transsexuals arising from administration of hormone and/or sex reassignment surgery. In this article, we represent a case of a 52-year-old "woman"found dead on the road-side. "She"was naked on the scene and supposed to be murdered by strangulation of he neck. Surprisingly, autopsy findings as well as DNA typing revealed that "she"was transsexual once a man. We discuss medicolegal problems posed by medico-surgical treatment in transsexuals.
Autopsy* ; DNA Fingerprinting ; Female ; Homicide ; Humans ; Middle Aged ; Neck ; Sex Reassignment Surgery ; Transsexualism