The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Mar 2008
Asphyxia: a rare cause of death for motor vehicle crash occupants.
Motor vehicle related trauma is one of the leading causes of traumatic death. Although most of these deaths are because of severe blunt force trauma, there are people without severe injury who die of asphyxia related to the motor vehicle collision. There were 37 deaths because of motor vehicle related asphyxia in San Diego County during 1995-2004. ⋯ Positional asphyxia occurred in positions interfering with normal respiration, including inversion. None of the occupants had injury severe enough to result in death at the scene if they had not first died of asphyxia. This study suggests classifying the mechanism of asphyxia for these fatalities may be a challenge to forensic pathologists who seldom see these rare deaths.
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Am J Forensic Med Pathol · Mar 2008
Case ReportsThe spectrum of findings in cases of sudden death due to blunt cardiac trauma--'commotio cordis'.
Commotio cordis is a term used for cases of sudden cardiac death due to nonpenetrating chest trauma without evidence of underlying myocardial disease or injury. Contusio cordis has been reserved for cases of chest trauma where there is cardiac bruising. Three deaths due to blunt cardiac and chest trauma after vehicle accidents are presented where the only significant injuries were contusions of the heart and fractures of the sternum and ribs. ⋯ Given that individuals with cardiac bruising, chest trauma, coronary atherosclerosis, and alcohol intoxication may still die of the same mechanisms as in classic commotio cordis, and that these entities represent a spectrum of findings after chest impact, it may be more useful to separate cases into related subcategories: (A) those with no evidence of injury or underlying cardiovascular disease, (B) those with chest wall fractures, chest wall contusions and/or cardiac contusions, and (C) those with underlying cardiovascular disease or the presence of substances such as alcohol or drugs that may reduce the threshold for cardiac arrhythmias. As there may be cases with a number of these factors, a fourth category (D) includes those with a combination of injuries and predisposing factors (ie, categories B and C). Including cases such as these under the diagnostic umbrella of commotio cordis may demonstrate that a wider range of individuals are at risk for death from blunt cardiac trauma than sports-playing adolescents.
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Am J Forensic Med Pathol · Mar 2008
Case ReportsHeart luxation and myocardium rupture in postmortem multislice computed tomography and magnetic resonance imaging.
Postmortem cross-sectional imaging in situ of nontraumatic human heart and of the heart with a penetrating trauma has already been described. In postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) the diagnosis of blunt trauma to the heart was reported to be challenging. We examined a case of fatal vehicle accident with severe heart trauma, which underwent postmortem MSCT and MRI before autopsy. ⋯ Based on this finding a rupture of the pericardium was suspected. T2-weighted MRI sequence and MSCT images allowed for diagnosis of myocardium rupture. We conclude that postmortem MSCT and MRI performed in suspicion of blunt trauma to the heart in forensic cases are useful documentation and diagnostic tools.
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Am J Forensic Med Pathol · Mar 2008
Case ReportsFatal anaphylaxis to indoor native fire ant stings in an infant.
The red (Solenopsis invicta) and black (Solenopsis richteri) imported fire ants (IFA) are a common cause of venom allergy in the southeastern United States. Hypersensitivity to stings of native fire ants is less common, although anaphylaxis has been reported to various native Solenopsis species. There have been numerous reports of indoor stings caused by IFA, including in nursing homes and private residences. ⋯ There is significant cross-reactivity among the venoms of Solenopsis species, although some species' specificity exists for the Sol 2 allergen. Testing and treatment with IFA whole-body extract is likely to be to be effective for native fire ant allergy. A mixture of S. invicta and S. richteri extracts should be considered when native fire ant species are presumed to cause the primary sensitization to reduce the chance that species-specific reactivity is missed.