Case 3 -

Sudden Non-Traumatic Cardiovascular Death William D. Edwards Mayo Clinic Rochester, MN

Click on each slide thumbnail image for an enlarged view

Click here to view (or print) handout in single page format. (5.83 MB) Note: Any slides will be printed in color. Click here to view (or print) black and white handout. (1.46 MB) Note: Text will be in single page format and any slides will be in 6-per-page format. Clinical Summary: A 59-year-old woman was staying in Rochester, Minnesota, with her husband while he was recuperating following surgery at the Mayo Clinic. On the night of her death, she was last seen alive at 9:30 p.m. and was found dead in bed by her daughter at 12:30 a.m. There was no evidence of suicide or foul play. The county coroner ordered an autopsy. According to the husband and daughter, she had been in good general health but had recently complained of nausea, exhaustion, and swollen feet. She was obese. There was also a long-standing history of polycythemia vera and a remote history of poliomyelitis. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Right ventricle, hypertrophy and dilatation (basal short-axis view). Case 3 - Figure 2 Right ventricle, marked myocyte hypertrophy (H&E x100). Case 3 - Figure 3 Muscular pulmonary artery, old organized thrombus (H&E x50). Case 3 - Figure 4 Muscular pulmonary artery, old organized thrombus (H&E x50). Case 3 - Figure 5 Muscular pulmonary artery, old organized thrombus (H&E x50). Case 3 - Figure 6 Muscular pulmonary artery, old organized thrombus (H&E x50). Case 3 - Figure 7 Muscular pulmonary artery, eccentric intimal fibrosis (H&E x50). Case 3 - Figure 8 Muscular pulmonary artery, eccentric intimal fibrosis (H&E x50). Case 3 - Figure 9 Muscular pulmonary artery, recent occlusive thrombus (H&E x50). Case 3 - Figure 10 Muscular pulmonary artery, mild medial hypertrophy (VVG x50). References Weber MA, Ashworth MT, Sebire NJ. Portopulmonary hypertension in childhood presenting as sudden death. Pediatr Dev Pathol 2006;9:65-71. Srigley JA, Pollanen MS. Sudden death with clinically undiagnosed pulmonary hypertension. J Clin Forensic Med 2005;12:264-267. Khattar RS, Fox DJ, Alty JE, Arora A. Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension. Heart 2005;91:142-145. Arena V, De Giorgio F, Abbate A, Capelli A, De Mercurio D, Carbone A. Fatal pulmonary arterial dissection and sudden death as initial manifestation of primary pulmonary hypertension: a case report. Cardiovasc Pathol 2004;12:230-232. Moscoso G, Mieli-Verhani G, Mowat AP, Portmann B. Sudden death caused by unsuspected pulmonary arterial hypertension, 10 years after surgery for extrahepatic biliary atresia. J Pediatr Gastroenterol Nutr 1991;12:388-393. Ackerman DM, Edwards WD. Sudden death as the initial manifestation of primary pulmonary hypertension: report of four cases. Am J Forensic Med Pathol 1987;8:97-102. Brown DL, Wetli CV, Davis JH. Sudden unexpected death from primary pulmonary hypertension. J Forensic Sci 1981;26:381-386.