Abstract
Pulmonary ThromboEmolism (PTE) is an important disease for legal medicine. Because of their sudden lethal onset, generally medicolegal autopsies show few clinical information when PTE is the cause of death. During medicolegal autopsies, the autopsy operator must answer to important questions. For example, autopsy operator can need to assess the casual relationship between PTE and recent accident, such as trauma or long air travel. Furthermore, the autopsy operator needs to investigate the pathology of PTE as a cause of sudden cardiovascular death. It is relatively simple to confirm a fatal massive thromboembolus in the initial stage of thoracic investigations, but sometimes it might be difficult to distinguish this from postmortem clot. In such cases histopathological examination can help in the differentiation. Histological examination is also required for observation of chronological changes of the thrombi. Chronological evaluation is an important factor especially to determine whether the death coincides with the date of a specific accident/event or instead there is an earlier onset of PTE. In addition, histological sections sometimes show additional information, such as tumor fragments in cases of malignancy or small fragments of bone marrow in cases of active resuscitation, that can be useful in a medicolegal scenario. Furthermore, new diagnostic tools are arising, which they can be very helpful in the individuation of this frequently underdiagnosed disease. The goal of our work is to investigate these aspects through the review of the recent literature.
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References
Byard RW (2013) Fatal embolic events in childhood. J Forensic Legal Med 20(1):1–5
Dedouit F, Otal P, Loubes-Lacroix F, Rousseau H, Costagliola R, Telmon N, Joffre F, Rouge D (2006) Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis. Forensic Sci Int 158(2–3):190–194
Dilley A, Austin H, Hooper WC, Lally C, Ribeiro MJ, Wenger NK et al (1998) Relation of three genetic traits to venous thrombosis in an African-American population. Am J Epidemiol 147(1):30–35
Dunnill MS (1987) Pulmonary pathology, 2nd edn. Livingstone, Churchill, pp 283–331
Elhammady G, Schubeck AT, El-Najjar V, Robinson MJ (2011) Postmortem demonstration of the source of pulmonary thromboembolism: the importance of the autopsy. Case Rep Vasc Med 2011:108215
Fineschi V, Turillazzi E, Neri M, Pomara C, Riezzo I (2009) Histological age determination of venous thrombosis: a neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int 186(1–3):22–28
Fineschi V, Bafunno V, Bello S, De Stefano F, Margaglione M, Neri M, Riezzo I, Turillazzi E, Bonsignore A, Vecchione G, Ventura F, Grandone E (2012) Fatal pulmonary thromboembolism. A retrospective autopsy study: searching for genetic thrombophilias (Factor V Leiden (G1691A) and FII (G20210A) gene variants) and dating the thrombus. Forensic Sci Int 214(1–3):152–158
Freiman DG, Suyemoto J, Wessler S (1965) Frequency of pulmonary thromboembolism in man. N Engl J Med 272:1278–1280
Fujita S, Hirota S, Oda T, Kato Y, Tsukamoto Y, Fuji T (2000) Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan. Clin Orthop Relat Res 375:168–174
Grabherr S, Doenz F, Steger B et al (2011) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Leg Med 125:791–802
Guyatt GH, Akl EA, Crowther M, Schünemann HJ, Gutterman DD, Zelman LS, American College of Chest Physicians (2012) Introduction to the ninth edition: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):48S–52S
Hira B, Pegoraro RJ, Rom L, Moodley J (2003) Absence of factor V Leiden, thrombomodulin and prothrombin gene variants in Black South African women with preeclampsia and eclampsia. Br J Obstet Gynaecol 110(3):327–328
Hitosugi M, Yufu T, Kido M, Yokoyama T, Nagai T, Tokudome S, Joh K (2005) Sudden death due to pulmonary thromboembolism after car driving: a case report. Med Sci Law 45(2):179–181
Hooper WC, Roberts S, Dowling N, Austin H, Lally C, Whitsett C (2006) The prevalence of the prothrombin gene variant C20209T in African-Americans and Caucasians and lack of association with venous thromboembolism. Thromb Res 118(6):767–768
Irninger W (1963) Histologische Altersbestimmung von Thrombosen und Embolien. Virchows Arch Pathol Anat 336:220–237
Itakura H (2005) Racial disparities in risk factors for thrombosis. Curr Opin Hematol 12(5):364–9
Kroegel C, Reissig A (2003) Principle mechanisms underlying venous thromboembolism: epidemiology, risk factors, pathophysiology and pathogenesis. Respiration 70(1):7–30
Leu AJ, Leu HJ (1989) Spezielle Probleme bei der histologischen Altersbestimmung von Thromben und Emboli. Pathologe 10:87–92
Margiotta G, Carnevali E, Gabbrielli M, Bacci M, Lancia M (2014) Report of a fatal case of pulmonary thromboembolism in a long-distance truck driver. Am J Forensic Med Pathol 35(4):242–245
Matsumoto H, Yamamoto K, Abiru H, Yamamoto Y, Hayase T, Ojima K, Matsubayashi K, Fukui Y (1994) Sudden and unexpected death due to undiagnosed pulmonary thromboembolism in an adolescent male without previous history of trauma. Nihon Hoigaku Zasshi 48(5):343–348
Me DB (1954) A critical evaluation of the problem of thromboembolism. Int Abstr Surg 98(1):1–27
Mobilia F, Casali MB, Gallieni M, Genovese UR (2014) Lethal pulmonary thromboembolism: an autopsy-based study on a rare but legally relevant event. Med Sci Law 54(2):78–83
Montisci M, Snenghi R, Pasquali A, Prandoni P, Ferrara SD (2003) Profiles of medical malpractice in the prophylaxis of pulmonary thromboembolism. Ital Heart J Suppl 4(3):217–225
Morpurgo M, Schmid C (1980) Clinico-pathological correlations in pulmonary embolism: a posterior evaluation. Pulmonary embolism (Progress in Respiration Research vol 13), 1st edn. Karger, Basel: Switzerland, p 8–15
Morrell MT, Dunnill MS (1967) Fibrous bands in conducting pulmonary arteries. J Clin Pathol 20:139–144
Moser KM, Bloor CM (1993) Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 103:685–692
Murai T, Baba M, Ro A, Murai N, Matsuo Y, Takada A, Saito K (2001) Sudden death due to cardiovascular disorders: a review of the studies on the medico-legal cases in Tokyo. Keio J Med 50(3):175–181
Nosaka M, Ishida Y, Kimura A, Kondo T (2010) Time-dependent organic changes of intravenous thrombi in stasis-induced deep vein thrombosis model and its application to thrombus age determination. Forensic Sci Int 195(1–3):143–147
Nosaka M, Ishida Y, Kimura A, Hama M, Kawaguchi T, Yamamoto H, Kuninaka Y, Shimada E, Kondo T (2015) Immunohistochemical detection of intrathrombotic IL-6 and its application to thrombus age estimation. Int J Legal Med 129(5):1021–1025
Pomara C, Bello S, Grilli G, Guglielmi G, Turillazzi E (2015) Multi-phase postmortem CT angiography (MPMCTA): a new axillary approach suitable in fatal thromboembolism. Radiol Med 120(7):670–673
Prandoni P, Polistena P, Bernardi E et al (1997) Upper-extremity deep vein thrombosis: risk factors, diagnosis, and complications. Arch Intern Med 157(1):57–62
Ro A, Kageyama N, Tanifuji T, Kobayashi M, Takada A, Saito K, Murai T (2003) Histopathological study of pulmonary arteries in 14 autopsy cases with massive pulmonary thromboembolism. Leg Med (Tokyo) 5(Suppl 1):S315–S317
Ro A, Kageyama N, Tanifuji T, Fukunaga T (2006) The mechanism of thrombi formation, propagation and embolization of calf-type deep vein thrombosis resulting in massive pulmonary thromboembolism. Jpn J Phlebol 17:197–205
Ro A, Kageyama N, Tanifuji T, Fukunaga T (2008) Pulmonary thromboembolism: overview and update from medicolegal aspects. Leg Med (Tokyo) 10(2):57–71
Ro A, Kageyama N, Tanifuji T, Sakuma M (2011) Autopsy-proven untreated previous pulmonary thromboembolism: frequency and distribution in the pulmonary artery and correlation with patients’ clinical characteristics. J Thromb Haemost 9(5):922–927
Sakon M, Maehara Y, Yoshikawa H, Akaza H (2006) Incidence of venous thromboembolism following major abdominal surgery: a multicenter, prospective epidemiological study in Japan. J Thromb Haemost 4:581–586
Siragusa S, Piovella F, Barone M, Beltrametti C (1996) Venous thromboembolism: epidemiology and risk factors. Minerva Cardioangiol 44(11):581–589
Sotunmbi PT, Idowu AT, Akang EE, Aken’Ova YA (2006) Prevalence of venous thromboembolism at post-mortem in an African population: a cause for concern. Afr J Med Med Sci 35(3):345–348
Steiner I (2007) Pulmonary embolism – temporal changes. Cardiovasc Pathol 16(4):248–251
Van Beek EJR, Charbonnier B, Meyer G, Morpurgo M, Palla A, Perrier A (2000) Guidelines on diagnosis and management of acute pulmonary embolism. Task force on pulmonary embolism, European society of cardiology. Eur Heart J 21(16):1301–1336
Wagenvoort CA (1995) Pathology of pulmonary thromboembolism. Chest 107:10S–17S
White RH, Keenan CR (2009) Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 123(Suppl 4):S11–S17
Widimsky J, Maly J (2005) Acute pulmonary embolism and venous thrombosis, 2nd edn. Triton, Prague7, p 13–14
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Margiotta, G., Coletti, A., Severini, S., Tommolini, F., Lancia, M. (2016). Medico-Legal Aspects of Pulmonary Thromboembolism. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_130
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DOI: https://doi.org/10.1007/5584_2016_130
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