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Deaths Due to Asphyxiant Gases
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
The odor of HCN (smell of bitter almonds) can be detected on opening the body. Tracheal congestion and hemorrhages present. Stomach shows hemorrhagic gastritis (corrosive nature). Mucosa shows blackened and eroded surface with peculiar smell. Lungs are congested and edematous with subpleural or confluent alveolar hemorrhages are seen and on cut section exudes blood mixed with froth suggestive of pulmonary edema. Brain softened and edematous. 21 Congestion of lung liver kidney gastrointestinal tract is found. Disseminated petechia are present over the pleura, lungs, brain, meninges and pericardium.22
Granulomatous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Albert Alhatem, Robert A. Schwartz, Muriel W. Lambert, W. Clark Lambert
Overview: Purpuric eruptions are subdivided into two types: non-thrombocytopenic (normal platelet) and thrombocytopenic (low platelet). Purpura may result from compromising the vessel walls (trauma, infection, vasculitis, collagen disorders) or due to hemostatic pathology (thrombocytopenia, abnormal platelet function, clotting factor deficiency, or abnormal clotting factor function). Other conditions may be associated with petechiae, including septicemia, immune thrombocytopenia (ITP), hemolytic uremic syndrome, leukemia, and coagulopathies (e.g., hemophilia). Non-thrombocytopenic purpura may result from coagulation disorders, connective tissue disorders, scurvy, or vasculitis. Thrombocytopenic purpura may be due to medications, immune disorders, septicemia, Rocky Mountain spotted fever, or systemic lupus erythematous.
Scalp, facial and gunshot injuries
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The smallest pattern of bleeding is a petechial haemorrhage or a petechia. Petechiae are pinhead-sized areas of bleeding found in the skin and internal organs. Although often described as a sign of asphyxia, they are by no means specific and are seen in a number of different causes of death, as well as non-fatal cases. In the head, they can be seen in the eyes (Figure 6.6a) and eyelids, on the face and behind the ears, as well as sometimes on mucosal surfaces (Figure 6.6b). Petechial-type haemorrhages on the undersurface of the scalp found following dissection are a well-recognised artefact and should not be interpreted as arising ante-mortem (see Chapter 5). In the absence of other external petechiae such as may be seen in external pressure to the neck, they are meaningless in determining the mode of death.
Neuroimaging in professional combat sports: consensus statement from the association of ringside physicians
Published in The Physician and Sportsmedicine, 2023
The CT is extremely sensitive in detecting the stigmata of acute TBI such as bleeding and bone pathology (craniofacial fractures, fractures of the orbits). It has the added advantage of widespread availability, short scan time, and low cost. The MRI is superior to a CT for detecting the stigmata of chronic TBI [1,6]. The ability of the MRI to detect hematomas improves over time as the composition of the blood changes [1,6]. The overwhelming majority of patients with mild brain injury frequently show no parenchymal abnormality on MRI [1,6]. However, coincidental structural brain abnormalities are found in about 2–3% of all studies, including meningiomas, coincidental, and non-pathologic anomalies, and small often unruptured cerebral aneurysms [1]. Small circle of Willis cerebral aneurysms are better visualized with CT or MR angiography. Large arteriovenous malformations (AVMs) can be readily identified on CT and MRI [7]. With reference to contact sports, relevant abnormalities include hemorrhagic cortical contusions, petechiae, or foci of altered signal that represent white matter shear injury (diffuse axonal injury) [1,5,6]. When petechiae resolve, they can leave a permanent hemosiderin deposition on the MRI [1]. While the MRI is superior to a CT in the detection of axonal injury, it is insensitive in detecting acute hemorrhage (oxy-Hgb and deoxy-Hgb) within 48–72 h after injury; emphasizing the value of CT without contrast in rapid triage of patients with acute TBI.
Liver Cirrhosis Due to Fetal CMV Infection: A Case Report
Published in Fetal and Pediatric Pathology, 2023
Selvi Aydın Şenel, Kübra Kurt Bilirer, Selma Acar, Hakan Erenel
A 24-year-old woman gravida-1-para-0 at 20 weeks gestation was referred to our department due to fetal ascites. We observed fetal ascites, increased middle cerebral artery peak systolic velocity (1.98 MoM), placentomegaly, oligohydramnios, growth restriction and hyperechogenic bowel on ultrasound. Examination of fetal head showed asymmetrical echogenic areas in both hemispheres and midline shift suggesting severe intracerebral hemorrhage. We performed an amniocentesis followed by PCR testing for cytomegalovirus. CMV-DNA-PCR analysis was positive in the amniotic fluid. Termination of pregnancy was performed after counseling of the couple. The postabortal gross examination showed petechial lesions on the skin. Autopsy confirmed intracerebral hemorrhage. Macroscopic appearance of the fetal liver was nodular resembling macronodular cirrhosis (Fig. 1). We observed cytomegalic cells and "owl's eye" nuclear inclusion bodies (large eosinophilic inclusions surrounded by a clear halo) in the liver using immunohistochemical staining (Fig. 2a, b). Necrosis and fibrosis were highlighted by the reticulin stain (Fig. 2c, d). Prussian blue was used to exclude iron storage disorders. Histopathological diagnosis of cirrhosis was made.
How I approach new onset thrombocytopenia
Published in Platelets, 2020
The primary consideration in any new patient with thrombocytopenia is a rapid exclusion of life-threatening disorders, either due to bleeding risk or other underlying pathology, such as thrombotic thrombocytopenic purpura (TTP). The bleeding history and physical signs, such as petechiae and ecchymosis can be rapidly assessed. Several bleeding assessment tools have been proposed and validated in ITP and hereditary bleeding disorders, but these generally relate to chronic bleeding pattern and are of more use in clinical trials and determining the impact of a therapeutic intervention over time [3,4] than assessing immediate bleeding risk. “Wet” purpura in the mucous membranes has traditionally been regarded as a presage of increased bleeding risk [5], although hard data supporting this mantra is elusive [6]. An indication of the chronicity, based on symptoms or historical blood counts is also important, as newly discovered thrombocytopenia does not always imply new onset. Prompt confirmation of thrombocytopenia through the exclusion of pseudothrombocytopenia and review of the blood film for critical findings (such as schistocytes in microangiopathic hemolytic anemia (MAHA)) should occur concurrently to clinical assessment (see Figure 1).