Postmortem inspection is a specialized medical practice that determines the cause and manner of death via external examination of a corpse. It is performed as part of the medico-legal death investigation and a crucial step in determining whether an autopsy is necessary. In South Korea, training for doctors performing postmortem inspection and quality control for postmortem inspection results remain lacking. Therefore, the Korean Society for Legal Medicine established a task force and proposed a standard operating procedure (SOP) of postmortem inspection. This article includes the background for proposing this SOP, an introduction to the postmortem inspection process, and the principles for performing the procedure and writing the report. This SOP may serve as a basic guideline for postmortem inspection.

Fatal hemorrhage from vascular access is a rare but life-threatening complication in patients undergoing hemodialysis. Determining the cause and manner of unwitnessed death is challenging, highlighting the importance of forensic evaluation. A 62-year-old woman undergoing long-term hemodialysis was found dead in her bathroom. Scene investigation revealed extensive bright-red blood loss and multiple bloodstain patterns. External examination revealed a 5 cm oval-shaped bulging lesion at the arteriovenous fistula site on the left upper arm, consistent with a pseudoaneurysm. The overlying skin was thinned with whitish discoloration, and two focal dark reddish lesions at the center, one with a ruptured defect. No other significant injuries were found. Death was attributed to massive hemorrhage from arteriovenous fistula rupture. Based on scene findings and external examination, homicide and suicide were excluded; necrotic changes indicated progressive deterioration, confirming spontaneous rupture. This case demonstrates that pseudoaneurysm formation and skin changes in arteriovenous fistulas may lead to fatal hemorrhage. Careful evaluation of morphological features and scene findings is essential for determining the cause and manner of death in unwitnessed cases.

Background: Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. Methods: We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method. Results: Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). Conclusion Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.

Percutaneous epidural neuroplasty (PEN) is an interventional technique used to manage spinal pain. However, the procedure may lead to various complications, such as dural puncture and inadvertent intrathecal injection of contrast agents. Conventional autopsy techniques may have limitations in identifying these complications, but postmortem computed tomography (PMCT) scans may be helpful in this respect. The pseudosubarachnoid hemorrhage sign on a PMCT scan is an important finding that suggests an inadvertent intrathecal injection of a contrast agent during the procedure. Here, we report on two rare cases of intrathecal contrast injection that mimicked a subarachnoid hemorrhage after PEN. These rare cases should be considered during autopsies of PEN-related deaths, and a PMCT scan should always be performed prior to such autopsies.

Background/Aims: Most studies on hospital-acquired pneumonia (HAP) have been conducted in intensive care unit (ICU) settings. This study aimed to investigate the microbiological and clinical characteristics of non-ICU-acquired pneumonia (NIAP) and to identify the factors affecting clinical outcomes in Korea. Methods: This multicenter retrospective cohort study was conducted in patients admitted to 13 tertiary hospitals between July 1, 2019 and December 31, 2019. Patients diagnosed with NIAP were included in this study. To assess the prognostic factors of NIAP, the study population was classified into treatment success and failure groups. Results: Of 526 patients with HAP, 379 were diagnosed with NIAP. Overall, the identified causative pathogen rate was 34.6% in the study population. Among the isolated organisms (n = 113), gram-negative bacilli were common pathogens (n = 91), such as Pseudomonas aeruginosa (n = 25), Acinetobacter baumannii (n = 23), and Klebsiella pneumoniae (n = 21). The multidrug resistance rates of A. baumannii, P. aeruginosa, and K. pneumoniae were 91.3%, 76.0%, and 57.1%, respectively. Treatment failure was significantly associated with K. pneumoniae (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.35 to 9.05; p = 0.010), respiratory viruses (OR, 3.81; 95% CI, 1.34 to 10.82; p = 0.012), hematological malignancies (OR, 3.54; 95% CI, 1.57 to 8.00; p = 0.002), and adjunctive corticosteroid treatment (OR, 2.40; 95% CI, 1.27 to 4.52; p = 0.007). Conclusions The causative pathogens of NIAP in Korea are predominantly gram-negative bacilli with a high rate of multidrug resistance. These were not different from the common pathogens of ICU-acquired pneumonia.

Meckel’s diverticulum is the most common congenital malformation of the small intestine that can cause various complications, including obstruction, intussusception, inflammation, hemorrhage, or perforation. Littre hernia is a rare complication that refers to a Meckel’s diverticulum within the hernia sac. This condition is usually asymptomatic and is often discovered incidentally intraoperatively or at autopsy. Therefore, only extremely rare cases of death caused by Littre hernia are described in the literature. We report a rare case of unexpected death secondary to Littre hernia, which was diagnosed at the time of autopsy in a 71-year-old man.

This report describes an uncommon and fatal case of myocardial infarction due to coronary embolus arising from vegetation in the aortic valve with a background of infective endocarditis (IE). There are various causes of fatal IE. Myocardial infarction due to septic emboli is rare. We report a case of sudden death in a 69-year-old woman with hyperlipidemia and no known cardiac disease. She had severe general weakness and was hospitalized for colonoscopy. The patient unexpectedly presented with cardiac arrest and died. The autopsy showed total occlusion of the left anterior descending artery by an embolus, which originated from the septic vegetation of the aortic valve. Myocardial infarction from septic emboli associated with IE can be fatal and manifested as the first presentation. In autopsy practice of deceased patients with IE, careful examination of the coronary arteries is required.

Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.
Adult ; Aortic Rupture* ; Arteries ; Atherosclerosis ; Autopsy ; Collagen ; Collagen Type III ; Connective Tissue ; Counseling ; Ehlers-Danlos Syndrome* ; Female ; Humans ; Iliac Artery ; Inflammation ; Rupture ; Rupture, Spontaneous ; Skin ; Uterus ; Veins

BACKGROUND: There is a subjective disagreement about nuclear chromatin in the field of pathology. Objective values of red, green, and blue (RGB) light intensities for nuclear chromatin can be obtained through a quantitative analysis using digital images. METHODS: We examined 10 cases of well differentiated neuroendocrine tumors of the rectum, small cell lung carcinomas, and moderately differentiated squamous cell lung carcinomas respectively. For each case, we selected 30 representative cells and captured typical microscopic findings. Using an image analyzer, we determined the longest nuclear line profiles and obtained graph files and Excel data on RGB light intensities. We assessed the meaningful differences in graph files and Excel data among the three different tumors. RESULTS: The nucleus of hematoxylin and eosin-stained tumor cells was expressed as a combination of RGB light sources. The highest intensity was from blue, whereas the lowest intensity was from green. According to the graph files, green showed the most noticeable change in the light intensity, which is consistent with the difference in standard deviations. CONCLUSIONS: The change in the light intensity for green has an important implication for differentiating between tumors. Specific features of the nucleus can be expressed in specific values of RGB light intensities.
Chromatin ; Hematoxylin ; Image Processing, Computer-Assisted ; Light ; Lung ; Neuroendocrine Tumors ; Rectum ; Small Cell Lung Carcinoma