fibrin and Death--Sudden

Cardiac tumors other than myxomas are rare. We report a series of 10 intracavitary polypoid myofibroblastic proliferations in children and young adults emphasizing gross, histologic, and clinical features. There were 6 females and 4 males, with a mean age of 10 years (range 5 wk to 21 y). All lesions were endocardial-based, located in the right atrium (1), right ventricular inflow/tricuspid valve (1), right ventricular outflow (3), mitral valve (3), aortic valve/left coronary sinus (1), and left ventricular free wall (1). Symptoms included shortness of breath or dyspnea (3), syncope (2), chest pain (1), transient ischemic attacks (1), and fever with myalgias (1). All tumors were surgical resections, except 1 tumor that resulted in sudden coronary death and that was diagnosed at autopsy, and 1 tumor that embolized into the coronary artery and was treated by cardiac transplant. Two tumors, present in the aortic and mitral valves, respectively, caused cardiac ischemia. The tumors were polypoid or filiform and histologically resembled inflammatory myofibroblastic tumors of extracardiac sites, with loose spindle cell growth with sparse inflammation. Although there were frequent collagen bundles interspersed among the tumor cells, there were no large areas of dense fibrosis. Surface fibrin was present on the polypoid projections in 7 cases. Symptoms resulted from prolapse into coronary ostia or embolization, but no patient developed metastasis. Long-term follow-up in 2 patients demonstrated no evidence of disease or recurrence. Although metastatic potential was not identified, these tumors may result in serious symptoms, including myocardial infarct, syncope, and sudden death. These cardiac myofibroblastic tumors are readily distinguished from other endocardial-based cardiac tumors, including papillary fibroelastoma and myxoma, which may present clinically in the same manner.

Topics: Adolescent; Adult; Biomarkers; Child; Child, Preschool; Death, Sudden; Female; Fibrin; Granuloma, Plasma Cell; Heart Diseases; Humans; Infant; Male; Myocardial Infarction; Retrospective Studies; Syncope

Varicella (chickenpox) is one of the most frequent highly infectious diseases in childhood. It is caused by varicella-zoster virus. Lethal complications are rare. Focused on histological findings, we present a case of a sudden unexpected death of an otherwise healthy 18-month-old girl due to varicella-induced pneumonia. The histological and immunohistochemical investigations of the lung tissue revealed typical findings of a varicella pneumonia: haemorrhagic and necrotic nodules, intra-alveolar fibrin, numerous neutrophilic granulocytes, lymphocytes, plasmacells, macrophages, multinucleated giant cells and hyaline membranes. Varicella-related deaths are preventable by vaccine. To prevent complications and lethal outcome of varicella as reported here, the recommendations concerning vaccination against varicella must be taken into account in paediatric practice.

Topics: Adolescent; Chickenpox; Death, Sudden; Female; Fibrin; Forensic Pathology; Hemorrhage; Humans; Lung; Lymphocytes; Macrophages, Alveolar; Necrosis; Neutrophils; Plasma Cells; Pneumonia, Viral

A 69-year-old woman was admitted because of dyspnea. Thereafter, she fell into a state of shock. Resuscitation was attempted but she did not respond to it and died on the second hospital day. According to the autopsy findings, a wide range of area from the larynx to the trachea was covered with pseudomembrane. In the culture of bacteria, alpha Streptococcus and Corynebacterium genus (non-diphtherial) were all that was detected. These findings suggest that pseudomembranous lesion, an endogenous foreign matter of the air passage should be suspected when a patient presents with sudden dyspnea.

Topics: Aged; Airway Obstruction; Autopsy; Bronchitis; Corynebacterium; Death, Sudden; Dyspnea; Female; Fibrin; Humans; Neutrophils; Streptococcus pyogenes

The blood of patients dying suddenly possess the capacity of coagulation in vitro and then of transforming spontaneously into a liquid state, this being explained by the post-mortem fibrinolysis. Electron microscopic examination of this process allowed one to follow the dynamics of structural changes in the postmortem coagulates in the course of their spontaneous lysis and retraction in vitro. It is established that the main morphological criterion of the coagulates lysis is the destruction of fibrin fibrils and their degradation into the globular particles. Polynuclear leucocytes play an important role in the lysis of coagulates; they not only phagocytized the aggregated platelets and fibrin but seemed to release specific fibrinolytic factors into the coagulates. In the coagulates undergoing retraction, as distinct from those undergoing lysis, the destruction of platelet aggregates, strengthening and densening of the fibrin network are noted.

Topics: Blood Platelets; Clot Retraction; Death, Sudden; Erythrocytes; Fibrin; Fibrinolysis; Hemolysis; Humans; In Vitro Techniques; Microscopy, Electron; Neutrophils; Postmortem Changes

The coronary microcirculation was examined for platelet and fibrin thrombi in hearts from 21 normal subjects and 244 cardiac patients, including 168 with ischemic heart disease (IHD) and 76 with other types of heart disease. Seventy-seven cases were sudden cardiac death (SCD). No microthrombi were present in any of the normal hearts, whereas platelet and fibrin thrombin were present in the coronary microcirculation in 32 of 244 cardiac cases (13.1%), including 19 with IHD and 13 with other types of heart disease and after cardiac surgery. The microthrombi were either embolic or represented in situ thrombosis, depending upon the underlying pathologic process. There was no significant difference in the incidence of microthrombi in SCD patients, with IHD (10 of 50, 20%) compared with patients who survived longer (nine of 93, 10%). In SCD patients, however, platelet microthrombin were more frequent in patients less than 45 years of age compared with those older than 45 years of age (p = 0.0002). We concluded that coronary microcirculatory thrombi are not uncommon in heart disease. A subgroup of SCD in young patients with IHD has been identified in whom microcirculatory platelet thrombosis is the main cardiac pathologic process. The significance of this process is emphasized by the associated myocardial damage.

Topics: Adult; Aged; Blood Platelets; Cardiac Surgical Procedures; Coronary Circulation; Coronary Disease; Death, Sudden; Endocarditis; Female; Fibrin; Humans; Male; Microcirculation; Middle Aged; Myocardium; Thromboembolism

Topics: Acute Disease; Arteriosclerosis; Blood Platelets; Cardiac Output; Coronary Disease; Death, Sudden; Erythrocytes; Fibrin; Humans; Leukocytes; Myocardial Infarction

Topics: Blood Coagulation; Cadaver; Death, Sudden; Fibrin; Fibrinogen; Fibrinolysis; Fibrinolytic Agents; Forensic Medicine; Hot Temperature; Humans; Immunoelectrophoresis; Postmortem Changes; Streptokinase

Topics: Death, Sudden; Fibrin; Fibrinolysis; Fluorescent Antibody Technique; Forensic Medicine; Hemorrhage; Histocytochemistry; Humans; Immunochemistry; Phosphotungstic Acid; Skin

Topics: Autopsy; Blood Coagulation; Death; Death, Sudden; Deoxyribonuclease I; Fibrin; Fibrinolysis; Humans; Pathology; Streptodornase and Streptokinase; Streptokinase; Thrombolytic Therapy