Hígado nodular

Historia clínica: Varón de 61 años, bebedor y fumador, con EPOC severo, varices esofágicas, diabetes mellitus tipo 2 a tratamiento con hipoglucemiantes. Ingresa por neumonía extrahospitalaria y a las 72 horas hace un íleo paralítico de evolución tórpida a pesar de las medida habituales y fallece

Cuerpos de inclusión en las fibras miocárdicas de un paciente con epilepsia

Historia clínica:  Mujer de 20 años, con crisis epilépticas. Fallece por broncoaspiración. La sección histológica corresponde a corazón macroscópicamente normal

Estenosis aórtica

Historia clínica: Varón de 72 años, estenosis aórtica severa e infarto agudo de miocardio

Lesión tumoral en piel

Historia clínica: Mujer de 94 años ingresada por hemorragia digestiva alta. En la autopsia se encuentra tumor en: pulmones, ganglios linfáticos generalizados, suprarrenal, corazón y piel

Fallo hepático fulminante de etiología indeterminada

Historia clínica: Varón de 82 años que ingresa procedente de urgencias con el diagnóstico de insuficiencia hepática. Dolor abdominal de mes y medio de evolución y cuadro de diarrea. En los hallazgos de la autopsia destaca un pólipo pediculado de 5cm en intestino grueso

Riñones congestivos y hemorrágicos

Historia clínica: Mujer de 39 años ingresada por sospecha de púrpura trombótica trombocitopénica. Comienza con tratamiento esteroideo y sufre parada cardiorespiratoria que no remonta tras 40 minutos de reanimación

Recién nacido con sospecha de hemorragia cerebral

Historia clínica: Madre de 24 años, multigesta. Grupo sanguíneo A, Rh negativo. Antecedentes personales sin interés. Obstétricos: hijo sano a término de bajo peso y parto con ventosa. Dos abortos a los 3 y 2 meses. Embarazo de 32+4 semanas. Metrorragias en la última semana con dolor en hipogastrio, tratada con corticoides y ampicilina. Parto: con cesarea por desprendimiento placentario. Apgar: 3-5-7. Aguas sanguinolentas. Reanimacion. Varón de 2.025 gr, talla 46 cm, bajo peso, distress respiratorio. Durante su estancia: sangre en heces, ictericia (16 mg % al 5º dia de vida) y decaimiento. Al 4º dia: Palidez, cianosis distal, decaimiento, esplenomegalia , hepatomegalia. LCR: 1966 cels (hematíes recientes). Estudio de coagulación: déficit complejo protrombínico y fibrinógeno. Transfusión de plasma. Posible hemorragia cerebral. Empeoramiento clínico progresivo

Sudden death in the first trimester of pregnancy

como es sabido, entre las primeras causas de mortalidad materna durante el embarazo se encuentran los episodios de tromboembolismo venoso. Varios estudios poblacionales ya han demostrado que dicho riesgo se encuentra aumentado de manera muy significativa en caso de embarazos logrados mediante técnicas de Fertilización in vitro (FIV). Sin embargo, apenas existen casos en la literatura que ilustren estas situaciones de emergencia. Presentamos el caso de una mujer de 40 años, embarazada de mellizos mediante FIV, en su 12ª semana de gestación, que fallece tras dos días con clínica de mareos, taquicardia y ahogos. La finalidad de su publicación es doble: por un lado llamar la atención ante uno de los riesgos que acompañan la gestación y, por otro, poner en valor la función del médico forense y el estudio autópsico como fuente de recogida de información de salud pública.The venous thromboembolism and thromboembolic events remain the leading cause of death during pregnancy and postpartum in developed countries. Recent investigations have provided an important evidence of significantly increased risk of venous thromboembolism after in vitro fertilization (IVF) pregnancies. Nevertheless, there are few case reports showing these emergency situations. We report the case of a 40 years old woman, in her twelve week of a twin after IVF pregnancy, who dies after two weeks with dizziness, tachycardia and respiratory distress. Our objective is double: to highlight the risks of the pregnancy even in developed countries and, on the other hand, to enhance the role of the forensic pathologist and the forensic studies as epidemiological information gatherers

Histiocytoid cardiomyopathy and ventricular noncompaction presenting as sudden death in an adult male

Histiocytoid/oncocytic cardiomyopathy (HCM) is a rare, distinctive arrhythmogenic disorder that presents as arrhythmia or sudden death in infants and children. Ventricular noncompaction (VNC) is a rare cardiomyopathy characterized by a thickened endocardial layer of noncompacted myocardium and a thin epicardial layer of compacted myocardium. Only six cases of the association of both cardiomyopathies have been reported previously in the literature. All these cases were in children. To the best of our knowledge, a case of HCM has not been described in the adult. We report the case of a 45-year-old man with an increased heart weight and involvement of both ventricles by HCM and VNC cardiomyopathy. Besides, multiple foci of myocardial disorganization were detected. He died suddenly while hiking. The association of both processes HCM and VNC was an unexpected finding at autopsy. The death was linked to functional abnormalities of the cardiac histiocytoid cells, and it was favored by a state of abnormal development of the heart

Solitary fibrous tumor arising from the mesentery of adult patients. Report of two cases and review of the literature

Solitary fibrous tumors (SFTs) represent an uncommon entity most frequently manifested in the pleura. We describe herein two new cases located in the jejunal and sigmoid mesentery incidentally found in patients aged 61 and 32 years. In a review of the literature, we have compiled 15 mesenteric SFTs including our two cases. The mean age of the patients at presentation was 51.7 years (range, 26-83 years). Most patients were males (males:females 4:1). Although occasionally these tumors were an incidental finding, the majority have been symptomatic. Tumors varied greatly in size (3 to 25 cm), but most of them were large (mean 14.8 cm). Most cases (60%) were located in the small intestine mesentery. The hemangiopericytomatous (cellular) variant was the most common. All patients were treated by surgery and no other therapeutic approaches (chemo-/radiotherapy) were used. Follow-up data were available in 11 cases and ranged from six days to 21 years, with a mean follow-up period of 36.2 months. None recurred or metastasized. Two (13.3%) of the 15 cases showed atypical histological features concordant with histological, but not clinical malignancy. The main differential diagnosis includes gastrointestinal stromal tumor, synovial sarcoma and reactive nodular fibrous pseudotumor of the mesentery. In one third of the cases, tumor excision did not require intestinal resection. To our knowledge, our Case No. 1 is the first reported that has been removed through laparoscopic surgery. Radical surgery remains the treatment of choice. The unpredictable behavior of SFTs requires a careful, close, long-term follow-up