The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Dec 2014
Case ReportsSudden death due to anaphylactic shock in a patient with an intact hepatic hydatid cyst.
Hydatid disease of the liver is a parasitic infection primarily caused by the larvae of Echinococcus granulosus. Hydatid cysts may remain clinically silent for many years and are often an incidental finding on ultrasonography performed for unrelated reasons. Sudden death due to unrecognized hydatid cysts can occur, and rare case reports of this kind are present in the literature. ⋯ Sudden death in this case was attributed to anaphylactic shock caused by intravascular spread of the cyst contents. We believe that high intracystic pressure coupled with blunt trauma was the cause of leakage of cystic fluid into the bloodstream. In cases of sudden death in endemic areas, the possibility of a hydatid disease should be taken into consideration, especially if no other cause is evident.
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Am J Forensic Med Pathol · Dec 2014
Case ReportsLethal pulmonary air embolism caused by the removal of a double-lumen hemodialysis catheter.
Pulmonary air embolisms due to the removal of a central venous catheter are rare, but catheter removal is known to be a high risk factor for air embolism. In particular, the removal of a large catheter, such as a double-lumen hemodialysis catheter, can allow a large amount of air to enter into the bloodstream, which often results in sudden death. So, during catheter removal, special care should be taken to prevent air from entering blood vessels, for example, to ensure that the patient's head is tilted downward, that they have inhaled and are holding their breath, and that a covering gauze and inert ointment have been applied to the exit site. We report a lethal case of pulmonary air embolism caused by the removal of a double-lumen catheter from the right internal jugular vein of a patient who was sitting up and had not been instructed to hold their breath.
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Tapentadol (Nucynta) is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe acute pain. Its efficacy is believed to be due to μ-opioid receptor agonist activity and inhibition of norepinephrine reuptake resulting in increased norepinephrine concentrations. There is only one other case in the literature relating to the toxicity of this agent or report of a fatality. ⋯ The tapentadol concentration found in the heart blood submitted in this case was more than 20 times the upper limit of the therapeutic range. Possible mechanisms of death include respiratory depression, central nervous system depression, and serotonin syndrome. Based on the scene investigation and autopsy findings in this case, the medical examiner determined that the cause of death was narcotic (Nucynta) intoxication and the manner of death was undetermined.