Massive Bilateral Pulmonary Thromboembolism – A Bolt from the Blue Case Report
DOI:
https://doi.org/10.48165/jiafm.2024.46.1.21Keywords:
Cor pulmonale, Pulmonary thromboembolism, Sudden death, Venous thrombosisAbstract
Thrombosis originating from the deep veins of the lower limbs can result in recurrent emboli leading to acute on chronic pulmonary thromboembolism. The death in such situations would be sudden and unexpected due to acute right sided heart failure (cor pulmonale). There can be few preceding non-specific symptoms such as cough and/or dyspnoea, especially in non-hospitalised decedents. Many a time pulmonary thromboembolism is only detected in a medicolegal autopsy. The sudden and unexpected death in an apparently healthy individual paves the way for a police inquest procedures, and a medicolegal autopsy would be the only legal and logical alternative to find a closure. However, massive bilateral pulmonary thromboembolism occluding almost more than 80 percentage of the pulmonary artery vasculature is an extremely rare phenomenon in a medicolegal autopsy. This case report has been prepared to discuss on such a rare presentation, discovered during the medicolegal autopsy of an apparently healthy 46-year-old individual who collapsed on the sides of a road, and was brought dead to the hospital.
Downloads
References
Giuntini C, Ricco GD, Marini C, Melillo E, Palla A. Pulmonary embolism: epidemiology. Chest 1995; 107: 3s-9s.
Sakuma M, Okada O, Nakamura M, Nakanishi N, Miyahara Y, Yamada N, et al. Recent developments in diagnostic imaging techniques and management for acute pulmonary embolism: multicentre registry by the Japanese Society of Pulmonary Embolism Research. Intern Med. 2003; 42: 470-
Watanabe J, Iwabuchi K, Koseki Y, Fukuchi M, Shinozaki T, Miura M, et al. Declining trend in the in-hospital case-fatality rate from acute myocardial infarction in Miyagi Prefecture from 1980 to 1999. Jpn Circ J. 2001; 65: 941-946.
Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975; 17: 269-270.
Sasidharan A, Al-Kandary NM. Contriving an Opinion of Cause of Death in Autopsies. Indian J Forensic Med Toxicol. 2020; 14: 58-62.
Ayako R, Norimasa K, Takanobu T, Tatsushige F. Pulmonary thromboembolism: Overview and update from medicolegal aspects. Leg Med. 2008; 10: 57-71.
Grifoni S, Vanni S, Magazzini S, Olivotto I, Conti A, Zanobetti M, et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med. 2006; 23: 2151-2156.
Kjaergaard J, Schaadt BK, Lund JO, Hassager C. Quantitative measures of right ventricular dysfunction by echocardiography in the diagnosis of acute nonmassive pulmonary embolism. J Am Soc Echocardiogr. 2006; 19: 1264-1271.
Coma-Canella IC, Gamallo C, Onsurbe M, Lopez-Sendon J Indian Acad Forensic Med. 2024 Jan-Mar 46 (1) DOI : 10.48165/jiafm.2024.46.1.21Acute right ventricular infarction secondary to massive pulmonary embolism. Eur Heart J. 1988; 9: 534-540.
Ro A. Pathological study of fifty two forensic autopsy cases with acute massive pulmonary thromboembolism. Keio Med J. 2004; 81: 62-72.
Kageyama N, Tanifuji T, Ro A. Histopathological study of deep vein thrombosis in thirty-three patients with fatal pulmonary thromboembolism. J Jpn coll Angiol. 2002; 42: 187-191.
Kageyama N, Ro A, Tanifuji T, Fukunaga T. Significance of the Soleal Vein and its Drainage Veins in Cases of Massive
Pulmonary Thromboembolism. Ann Vasc Dis. 2008; 1: 35- 39.
Molina DK, Wood LE, Frost RF. Is routine histopathological examination beneficial in all medicolegal autopsies? Am J Forensic Med Pathol. 2007; 28:1-3.
Jani CB, Gupta S, Gupta M, Patel K, Shah M. Forensic Histopathology: Bane or a Boon. J Indian Acad Forensic Med. 2009; 31: 222-229.
Pathak A, Mangal HM. Histo-Pathology Examination in Medico-legal Autopsy Pros & Cons. J Indian Acad Forensic Med. 2010; 32: 128-130.
