Protocol of Investigation on Sudden Death at Autopsy, Including Molecular, Genetic and Toxicology Testing

The role of the autopsy: 1) Whether the death is ascribable to a natural or unnatural cause and when natural, if cardiac or extra-cardiac;2) The nosology of the cardiac diseases and the mechanism of cardiac death, whether arrhythmic or mechanical;3) If the cardiac disease is inherited, screening and counselling of the next of kin is required. About 30% of sudden deaths is ascribable to genetically determined morbid entities, mostly transmissible with the autosomal dominant pattern of inheritance, so that 50% of the first degree relatives are genetically affected (“carriers”) and exposed at risk;4) If toxic or illicit drug abuse was involved.

Liver pathology in COVID-19 related death and leading role of autopsy in the pandemic

BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome coronavirus 2 positive patients.METHODS A systematic literature search on PubMed was carried out until June 21,2022.RESULTS A literature review reveals that pre-existing liver disease and elevation of liver enzyme in these patients are not common;liver enzyme elevations tend to be seen in those in critical conditions.Despite the poor expression of viral receptors in the liver,it seems that the virus is able to infect this organ and therefore cause liver damage.Unfortunately,to date,the search for the virus inside the liver is not frequent(16%of the cases)and only a small number show the presence of the virus.In most of the autopsy cases,macroscopic assessment is lacking,while microscopic evaluation of livers has revealed the frequent presence of congestion(42.7%)and steatosis(41.6%).Less frequent is the finding of hepatic inflammation or necrosis(19%)and portal inflammation(18%).The presence of microthrombi,frequently found in the lungs,is infrequent in the liver,with only 12%of cases presenting thrombotic formations within the vascular tree.CONCLUSION To date,the greatest problem in interpreting these modifications remains the association of the damage with the direct action of the virus,rather than with the inflammation or alterations induced by hypoxia and hypovolemia in patients undergoing oxygen therapy and decompensated patients.

Understanding the Unique Characteristics of Suicide in China: National Psychological Autopsy Study

Objective To compare the characteristics of suicides in the four main demographic groups： urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China. Methods A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country. Results Pesticide ingestion accounted for 58% （519） of all suicides and 61% （3181519） of deaths were due to unsuccessful medical resuscitation. A substantial proportion （37%） of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% （76/563） received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion （79%）, the lowest prevalence of mental illness （39%）, and the highest acute stress from precipitating life events just prior to the suicide. Contusion Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.

Peritoneal bleeding due to percutaneous transhepatic gallbladder drainage:An autopsy report

A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.

An autopsy case of metastatic extramammary Paget’s disease treated with multimodality treatment including anti-HER2 therapy: What is the clinical and pathological significance of trastuzumab to the patient?

Advanced Extramammary Paget’s disease (AEMPD) shows a poor prognosis despite multimodality therapy. In recent years, it is suggested that anti-HER2 therapy may be promising for HER2-positive AEMPD. We herein present an autopsy case of a patient with AEMPD treated with multimodality treatment including anti-HER2 therapy. A 78-year-old man who diagnosed with AEMPD died after surgery and systemic chemotherapy including anti-HER2 therapy (trastuzumab). The metastatic skin lesions were immnohistologically HER2-positive. While the patients were administrated trastuzumab plus taxan (docetaxel, and paclitaxel) regimen, the metastatic skin lesion decreased, however, brain metastases were found in his brain and trastuzumab is discontinued. The skin metastasis rapidly spread over his body, leading to weakness, and he eventually died. At autopsy, the lesions of EMPD were extended distant organs including brain, although each metastasis was small and asymptomatic. The wide lesion of skin metastasis was exacerbated after discontinuation of trastuzumab, and transudate was observed due to the extensive necrosis and erosion. Our autopsy findings showed one progressive pattern of AEMPD, and indicated what is the clinical and pathological significance of anti HER2 therapy for HER2-positive AEMPD.

Immunohistochemistry panel segregates molecular types of hepatocellular carcinoma in Brazilian autopsy cases

AIM: To assess the distribution of proteins coded by genes reported as relevant for the molecular classification of hepatocellular carcinoma(HCC).METHODS: In this retrospective cross-sectional study, the following clinicopathological data were analyzed in 80 autopsied HCC patients: sex, age, ethnicity, alcohol intake, infection with hepatitis B and/or C virus, infection with human immunodeficiency virus, prior treatment, basic and immediate causes of death, liver weight, presence of cirrhosis, number and size of nodules, gross pattern, histological grade and variants, architectural pattern, invasion of large veins, and presence and location of extrahepatic metastases. The protein products of genes known to be involved in molecular pathogenesis of HCC, including epidermal growth factor receptor(EGFR), MET, keratin 19(K19), vimentin, beta-catenin, mechanistic target of rapamycin(m TOR), extracellular signaling-relatedkinase(ERK)1, ERK2, Ki67, cyclin D1, caspase 3 and p53, were detected by immunohistochemistry on tissue microarrays. The expression levels were scored and statistically assessed for correlation with HCC parameters. RESULTS: Infection with hepatitis C virus was identified in 49% of the 80 autopsy patients, cirrhosis in 90%, advanced tumors in 95%, and extrahepatic metastases in 38%. Expression of K19, p53 and ERK1 correlated to high-grade lesions. Expression of ERK1, nuclear beta-catenin, cyclin D1 and ERK2 correlated to higher rates of cell proliferation as determined by Ki67. Expression of MET, EGFR(> 0) and caspase 3 correlated with lower histological grades. Expression o f E G F R c o r r e l a t e d t o t h a t o f c a s p a s e 3, a n d overexpression of EGFR(≥ 200/300) was observed in low-grade tumors more frequently(grades 1 and 2: 67% vs grade 3: 27% and grade 4: 30%). Expression of ERK1 was associated with that of K19 and vimentin, whereas expression of ERK2 was associated with that of cyclin D1, MET and membrane beta-catenin. Expression of vimentin was strongly correlated with that of K19. CONCLUSION: Expression of K19, p53, ERK1, ERK2, vimentin and nuclear beta-catenin was related to highergrade markers, as opposed to expression/overexpression of EGFR, MET and caspase 3.

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.

Evaluating the quality of evidence for diagnosing ischemic heart disease from verbal autopsy in Indonesia

BACKGROUND Mortality and cause of death data are fundamental to health policy development.Civil Registration and Vital Statistics systems are the ideal data source,but the system is still under development in Indonesia.A national Sample Registration System(SRS)has provided nationally representative mortality data from 128 subdistricts since 2014.Verbal autopsy(VA)is used in the SRS to obtain causes of death.The quality of VA data must be evaluated as part of the SRS data quality assessment.AIM To assess the strength of evidence used in the assignment of Ischaemic Heart Disease(IHD)as causes of death from VA.METHODS The sample frame for this study is the 4,070 deaths that had IHD assigned as the underlying cause in the SRS 2016 database.From these,400 cases were randomly selected.A data extraction form and data entry template were designed to collect relevant data about IHD from VA questionnaires.A standardised categorisation was designed to assess the strength of evidence used to infer IHD as a cause of death.A pilot test of 50 cases was carried out.IBM SPSS software was used in this study.RESULTS Strong evidence of IHD as a cause of death was assigned based on surgery for coronary heart disease,chest pain and two out of:sudden death,history of heart disease,medical diagnosis of heart disease,or terminal shortness of breath.More than half(53%)of the questionnaires contained strong evidence.For deaths outside health facilities,VA questionnaires for male deaths contained acceptable evidence in significantly higher proportions as compared to those for female deaths.(P<0.001).Nearly half of all IHD deaths were concentrated in the 50-69 year age group(48.40%),and a further 36.10%were aged 70 years or more.Nearly two-thirds of the deceased were male(58.40%).Smoking behaviour was found in 44.11%of IHD deaths,but this figure was 73.82%among males.CONCLUSION More than half of the VA questionnaires from the study sample were found to contain strong evidence to infer IHD as the cause of death.Results from medical records such as electrocardiograms,coronary angiographies,and load tests could have improved the strength of evidence and contributed to IHD cause of death diagnosis.

Forensic Pathological Expertise of Medical Tangle Analysis of 139 Autopsy Cases

In this article , we report 139 autopsy cases of medical tangle , which were examined by the Department of Forensic Pathology, Faculty of Medicine, Tongji Medical University from Jan. 1972 to Dec. 1992.The emphasis is put on analyses of the status of medical tangle autopsy in forensic pathology, involved medical departments , distribution of victim's age and sex , differences between clinical diagnosis and autoptical conclusion, the composition and causes of medical tangle. The associated problems in forensic pathological autopsy are also discussed.

Aka Canturk Oral Autopsy Method for the Dental Identification of Fetus and Infant Cases

Forensic research requires the application of reliable identification methods for unidentified individuals, among which the dental analysis has prime importance. The most significant source of dental evidence is oral autopsy applications, which consist of an examination and evidence collection from the oral cavity of a deceased individual. Oral autopsies show variations depending on the age of the person due to rigor mortis. The oral autopsy of a child may require an easier operation than adults, and thus, the procedures are usually simpler for fetus or infant cases. The aim of this study is to propose the theoretical and experimental aspects of an oral autopsy protocol for a special age group of fetus or infant cases, which is a method for extracting tooth germs in their developmental stages for identification purposes and entitled by the authors’ names as the “Aka-Canturk Oral Autopsy Method”.

Autopsy Findings in a Case of Ellis Van Creveld Syndrome with Review of Literature

Ellis Van Creveld (EVC) syndrome is one of the congenital anomalies not compatible with life. It is also known as chondroectodermal dysplasia. The most common manifestations of this syndrome are short ribs, postaxial polydactyly, growth retardation, and ectodermal and cardiac defects. It has an incidence of one in every 60,000 live births and equal sex predisposition. In our case, perinatal autopsy was performed in a stillborn baby of 32 weeks of gestation having syndactyly, polydactyly and short forearms to know the cause of death and the diagnosis emerged as EVC syndrome. It is important to diagnose EVC syndrome as it is transmitted as an autosomal recessive disorder, so genetic counseling is required to make parents aware of the risk of recurrence.

Autopsy-Based Study of Abdominal Traffic Trauma Death after Emergency Room Arrival

We experienced the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvements identified in patients who died from traffic trauma and were considered by the quality improvement of education system. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study was conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meeting with accident was 13.5 hours, and compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were the liver followed by mesentery. We thought that delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.

Psychological Autopsy. A Possible Innovative Revision of the MAPI: Psychological Autopsy Structured on Individual Cases (PASIC)

The aim of this research is to propose an innovative technique of the psychological autopsy.Compared to the classic MAPI model,our procedure is structured on each single case by adapting the interview to the environmental circumstances,the socio-cultural characteristics of the subject examined and to the weapon used in the criminal act.We believe that this approach improves both confidence and compliance of the interviewee and the chances of obtaining information that could escape a standardized investigation.In one of the cold cases we studied,this new protocol led to the discovery of biological material coming from the crime scene,which had been secretly hidden by the subject for over 50 years.The aim of our work was also to coordinate the activity of the interviewer,trying to avoid repetition in the interviews that could lead to an alteration of the answers to the questions asked.In the first phase,questions with open-ended responses were preferred.In later stages,we asked specifically worded questions.We were careful not to formulate questions that had already been asked.It must be emphasized that for each case of psychological autopsy only one operator handled the interview.

Study of hypoechoic nodule diagnosis of BPH in outer gland of the prostate by TRUS and autopsy

To investigate the possibility of benign prostatic hyperplasia (BPH) in prostatic outer gland by transrectal ultrasound (TRUS) and autopsy examination.Methods Fifty-nine patients were biopsied by TRUS guided in sagittal and longitudinal sections,respectively,because hypoechoic nodules were found in the outer glands of the prostates.The specimens were stained by HE methods.The whole prostate specimens obtained from 16 men at autopsy were studied.Sonogram of the specimens was investigated by putting them in water.Them the specimens were sliced down perpendicularly to the urethra,histologically processed and stained by HE methods.Results Pathologically,22 of the 59 specimens were of benign prostate hyperplasia (BPH),29 of prostate cancer (PCa),1 of prostatic intraepithelial neoplasia (PIN) and 7 of tuberculosis (TB).A clear-cut interface between inner gland and outer gland,and multiple calculi and cysts were found on sonogram.Pathological diagnosis of BPH of the outer glands was made in all HE-stained autopsied specimens with varying degrees of hyperplasia of the glands,small muscles and stroma.Conclusion It is suggested that hypoechoic nodules in outer gland of the prostate by TRUS on sonogram may be benign hyperplastic nodules besides PCa,PIN,and TB.10 refs,5 figs.

High prevalence of hepatic steatosis and vascular thrombosis in COVID-19:A systematic review and meta-analysis of autopsy data

BACKGROUND Coronavirus disease 2019(COVID-19)disease can frequently affect the liver.Data on hepatic histopathological findings in COVID-19 is scarce.AIM To characterize hepatic pathological findings in patients with COVID-19.METHODS We conducted a systematic review with meta-analysis registered on PROSPERO(CRD42020192813),following PRISMA guidelines.Eligible trials were those including patients of any age and COVID-19 diagnosis based on a molecular test.Histopathological reports from deceased COVID-19 patients undergoing autopsy or liver biopsy were reviewed.Articles including less than ten patients were excluded.Proportions were pooled using random-effects models.Q statistic and I2 were used to assess heterogeneity and levels of evidence,respectively.RESULTS We identified 18 studies from 7 countries;all were case reports and case series from autopsies.All the patients were over 15 years old,and 67.2%were male.We performed a meta-analysis of 5 studies,including 116 patients.Pooled prevalence estimates of liver histopathological findings were hepatic steatosis 55.1%[95%confidence interval(CI):46.2-63.8],congestion of hepatic sinuses 34.7%(95%CI:7.9-68.4),vascular thrombosis 29.4%(95%CI:0.4-87.2),fibrosis 20.5%(95%CI:0.6-57.9),Kupffer cell hyperplasia 13.5%(95%CI:0.6-54.3),portal inflammation 13.2%(95%CI:0.1-48.8),and lobular inflammation 11.6%(95%CI:0.3-35.7).We also identified the presence of venous outflow obstruction,phlebosclerosis of the portal vein,herniated portal vein,periportal abnormal vessels,hemophagocytosis,and necrosis.CONCLUSION We found a high prevalence of hepatic steatosis and vascular thrombosis as major histological liver features.Other frequent findings included portal and lobular inflammation and Kupffer cell hyperplasia or proliferation.Further studies are needed to establish the mechanisms and implications of these findings.

An Autopsy and Histopathology-based Study to Ascertain the Cause of Death of Brought Dead Cases

Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These include the cases of sudden death,unexplained death,and unattended death.The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system,though there are some documented geographical,racial,and other variations.In the present study,we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved,in the deceased individuals of the contemporary Bengali population,with cases due to obvious unnatural causes being excluded.Materials and Methods:An observational,cross-sectional study with 105(n=105,male:89,female:16)study subjects of age group of 20-80 years,selected by systemic random sampling,from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012,excluding cases having a history of the obvious unnatural event.Organ system-wise gross examination was done,followed by tissue sampling for histopathological examination.The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.Results:In the present study,89 cases were male(84.8%)and 16 cases were female(15.2%),which reflects a male:female ratio of 5.56:1.The dead bodies are mostly recovered from the footpaths(47 cases,44%).Sixty-four(61%)cases are of known identity.In 54 cases out of 105(51.4%),morbid pathology is detected in the respiratory system(RS),lobar pneumonia,and cavitary pulmonary tuberculosis being the most frequent disease entity,in both genders.Fifty-one years-sixty-five years is found to be the most commonly affected age group,in both genders.Interpretation and Conclusions:The present study shows that the most common organ system involved in brought dead cases is the RS,which is supported by a few Indian studies.

Gastrointestinal tuberculosis:An autopsy-based study

Background:Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide.Gastrointestinal tuberculosis is an unusual presentation.It is defined as the involvement of any segment of the digestive tract,associated viscera,and peritoneum.The study’s main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia.Methods:This is a retrospective and descriptive study of autopsy reports.A total of 4,500 autopsies were performed between January 2004 and December 2020.The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization.Results:Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study.Most of the patients were male(n=35,72.9%)with a median age of 40.5 years old.Human immunodeficiency virus infection history was reported in 28 cases(58.33%).The most affected gastrointestinal tract site was the terminal ileum.Ulcers and thickened epithelium were common autopsies macroscopic findings.Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis.Conclusions:Gastrointestinal tuberculosis is a disease of great importance,being its diagnosis a clinical challenge.Underdiagnosis can be reported in a high percentage of cases,so autopsy diagnosis can help reveal more accurate data about this condition.

Histopathological impact of SARS-CoV-2 on the liver:Cellular damage and long-term complications

Coronavirus disease 2019(COVID-19),caused by the highly pathogenic severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),primarily impacts the respiratory tract and can lead to severe outcomes such as acute respiratory distress syndrome,multiple organ failure,and death.Despite extensive studies on the pathogenicity of SARS-CoV-2,its impact on the hepatobiliary system remains unclear.While liver injury is commonly indicated by reduced albumin and elevated bilirubin and transaminase levels,the exact source of this damage is not fully understood.Proposed mechanisms for injury include direct cytotoxicity,collateral damage from inflammation,drug-induced liver injury,and ischemia/hypoxia.However,evidence often relies on blood tests with liver enzyme abnormalities.In this comprehensive review,we focused solely on the different histopathological manifestations of liver injury in COVID-19 patients,drawing from liver biopsies,complete autopsies,and in vitro liver analyses.We present evidence of the direct impact of SARS-CoV-2 on the liver,substantiated by in vitro observations of viral entry mechanisms and the actual presence of viral particles in liver samples resulting in a variety of cellular changes,including mitochondrial swelling,endoplasmic reticulum dilatation,and hepatocyte apoptosis.Additional ly,we describe the diverse liver pathology observed during COVID-19 infection,encompassing necrosis,steatosis,cholestasis,and lobular inflammation.We also discuss the emergence of long-term complications,notably COVID-19-related secondary sclerosing cholangitis.Recognizing the histopathological liver changes occurring during COVID-19 infection is pivotal for improving patient recovery and guiding decision-making.

Differences in coronary microvascular lesions in coronary heart disease and hypertension:an autopsy study of elderly patients

Background In the case of hypertension, lesions in the microvessels of the target organs precede and deteriorate futher after arteriosclerosis in the small arteries. Thus coronary microvascular lesion (CML) was considered the crucial factor contributing to damage to the target organs. The purpose of this study is to observe the characteristics and differences of CML in autopsies of elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or EHT with CHD, given the same degree of left ventricular wall thickness (LVWT).Methods A retrospective study was performed on 246 cases of patients over 60 years old with EHT, CHD, or EHT with CHD, and on 26 cases without cardiovascular disease as controls , out of a total of 3195 consecutive autopsied cases. The arterioles (with diameter 10 -60 μm) and the capillaries in the cardiac muscle layer were examined by haematoxylin and eosin staining, elastic van Gieson staining, and CD31 immunohistochemistry. To quantify CML severity, measurements were taken of arteriole density (AD), the ratio of wall-to-lumen area of arteriole (RWL), and capillary density (CD), using light microscopy and computer image analysis. Based on LVWT, the cases were divided into four degrees, from Ⅰ to Ⅳ. The EHT, CHD, and EHT with CHD groups all rated LVWT Ⅰ -Ⅳ, and the control group rated LVWT Ⅰ. SAS software was used for statistical analysis.Results With the aggravation of LVWT, both AD and RWL increased while CD decreased significantly in the EHT group (P<0. 05 -0. 0001); there were similar but more severe changes in the EHT with CHD group (P<0. 001 -0. 0001); and AD increased (P <0.001) while RWL and CD did not change significantly in the CHD group.Conclusion Comparing EHT with CHD patients, there are similar patterns of change to AD, but different patterns of change to RWL and CD. CML is much more severe in EHT patients with CHD. We conclude that CML is one of the main causes of decreased coronary flow reserve and myocardial damage in both EHT patients and EHT patients with CHD.

Diagnostic imaging, preautopsy imaging and autopsy findings of 8 AIDS cases： a comparative study

Background Aquired immune deficiency syndrome （AIDS） presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS. Methods Autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations. Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegaJovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients. Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may resuJt in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.