Case 2. The patient was an elderly African American man with insulin-requiring diabetes (with multiple admissions for diabetic ketoacidosis), stroke (with immobility and difficulty swallowing, requiring gastrostomy and jejunostomy tube placement), hypertension and dementia who was noted to have a high blood glucose and lethargy at home. Paramedics were called. The patient underwent cardiorespiratory collapse en route to the hospital. Intubation was difficult requiring three attempts with varying size endotracheal tubes. The patient died in the emergency room.
Case 3. The patient was a middle-aged Caucasian man with history of smoking and recent left rib pain (medicated with ibuprofen) who was found dead after an unwitnessed collapse. Last contact with the family was one day prior.
Case 4. The patient was an elderly man in prior excellent health with history of possible asbestos exposure in the early 1970’s at a utility company. He was admitted approximately one month prior with diagnosis of pneumonia. He was found to have a mass in the left chest that protruded through the rib cage under the skin. It was determined radiographically to be of origin from the abdominal peritoneum, extending through the diaphragm and into the anterior chest wall under the skin. A secondary mass was identified under the sternum, possibly adherent to the pericardial fat. Initial biopsy was inconclusive. A follow-up biopsy showed sarcomatoid malignant mesothelioma. The patient’s father died at age 68 of myocardial infarction. There is no history of cancer in the family.
Case 5. The patient was an elderly Caucasian man with longstanding undiagnosed dementia.
Case 6. The patient was an elderly Caucasian woman who underwent lumbar spinal fusion surgery for degenerative disease. The patient required a second surgery for unknown complication and died in the weeks postoperatively. Limited history was available.
Case 7.The patient was a middle-aged Caucasian man with hypertension and obesity who had a prior head injury from a fall down stairs eight years prior with acute intracranial bleeding requiring craniotomy; and long-term complication of seizures treated medically. He had a temporary inferior vena cava filter placed prophylactically. The filter became embedded into the inferior vena cava wall and could not be surgically removed. He presented for medical attention two months before death with shortness of breath. Cardiovascular and infectious (viral) work-up were negative. On the day of death, he was noted to be sweating and with a right sided droop. The patient then collapsed, had a possible seizure and died.
Case 8. The patient was a middle-aged prior alcoholic with cirrhosis and with chronic renal disease of unknown etiology on peritoneal dialysis. The patient was evaluated for kidney vs. kidney-liver transplant. Transplant was deferred to due elevated transhepatic pressure. The patient underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure complicated intraoperatively by five minutes of hypotension during repositioning to a transplenic approach. The post-operative course was complicated by progressive elevation in liver function test, hepatic failure and then multi-organ failure over the course of a day. The patient underwent cardiopulmonary arrest and died.
Case 9. [The patient was a middle-aged Caucasian woman. The purpose of this video is to show a spleen dissection from our archives. There is only one video.]
Case 10. The patient was an elderly Caucasian man with history of chronic gastrointestinal bleeding requiring periodic blood transfusion. The patient underwent elective colonoscopy with polypectomy. Due to post-procedural malaise and abdominal pain, a computed tomography scan was performed which showed free air in the abdomen. The patient died several days later.
Case 11. The patient was an elderly Caucasian woman with recent bleeding per rectum, anemia and unspecified cardiac arrhythmia. She was hospitalized for her bleeding and received transfusions. An endoscopy did not find the source of the bleeding. Mobility at home was limited and she was scheduled for outpatient physical therapy. On descending the stairs at home going to her first physical therapy appointment, she became short of breath. She arrived at physical therapy where she collapsed and died.
Case 12. The patient was a middle-aged Caucasian man with diabetes, high blood pressure, high cholesterol and longstanding hydrocephalus who died at home after an unwitnessed cardiopulmonary arrest. He was found by the bed, fecally incontinent with his head pressed at the foot of the nearby dresser.
Case 13. The patient was an elderly Caucasian male with hypertension, insulin-dependent diabetes mellitus with history of diabetic comas and neuropathy, status post coronary a. bypass graft (CABG) surgery approximately 5 years prior, inability to walk, and multiple admissions to hospitals and rehabilitation centers over the past year for a variety of problems including dehydration, elevated ammonia, weight loss, congestive heart failure, food poisoning, pacemaker-defibrillator placement, deep right hip infection with MRSA and increasing ascites. The patient was in rehabilitation where he was found on the floor after an unwitnessed fall. There was concern for bruising. He died later that day.
Case 14. The patient was a middle-aged Caucasian man with a history of hypertension who was seen recently for extensive cardiac workup after complaints of chest discomfort. Work-up was negative. He complained the night before death of some possible chest tightness. He woke up in the morning, went to the bathroom, was observed to be short of breath and collapsed. Paramedics were called. The patient received advanced life support measures, including intubation, but died.
Case 15. The patient was a middle-aged Caucasian man with chronic pain related to a work injury to the right wrist. A prior surgery did not relieve his pain and he was on multiple pain medications. The patient died suddenly after an unwitnessed cardiopulmonary arrest.
Case 16. The patient was an elderly Caucasian man, status post kidney transplant who had longstanding undiagnosed dementia.
Case 17. The patient was a middle-aged Caucasian man with diabetes, high blood pressure, hypercholesterolemia, alcoholism and poor self-care. Here underwent repeated debridement of a left foot ulcer recently. He complained of continual “restless legs.” The patient was found after an unwitnessed cardiopulmonary arrest.
Case 18. The patient was a middle-aged Latino man with history of clipped cerebral aneurysm approximately five years prior, obesity and recent dyspnea on exertion and headache. The patient died suddenly after an unwitnessed cardiopulmonary arrest.
Case 19. The patient was a middle-aged Caucasian woman with history of knee surgery and recent dizziness (typically while standing from bending over position) and difficulty walking. The patient’s mother had a history of multiple malignancies, including a left frontal meningioma and lung cancer. The patient died suddenly.
Case 20. The patient was a middle-aged Latino man with history of clipped cerebral aneurysm approximately five years prior, obesity and recent dyspnea on exertion and headache. The patient died suddenly after an unwitnessed cardiopulmonary arrest.
Case 21. The patient was a middle-aged Caucasian woman status post left breast lumpectomy and radiation therapy for ductal carcinoma in situ three years prior with follow-up maintenance chemotherapy regimen; hypertension; and alcoholism. There was a change in medication approximately 2 months prior due to symptoms of abdominal pain and weight loss. Once the medication was stopped, her symptoms resolved; however, the patient was noted to have 40 lb. weight loss overall prior to death. The patient was normally functioning the night before her death and was found unresponsive in bed by her boyfriend after an unwitnessed cardiopulmonary arrest.
Case 22. The patient was a middle-aged African American woman with history of psychiatric condition, obesity and recent weight loss. The patient was transferred from her long-term residence to a hospital after an unspecified event in which she was found face down. Admission work-up included evaluation for a possible, unspecified respiratory issue. She received medical management and was transferred to a rehabilitation center for possible, unspecified wound management. The patient died under unknown circumstance in the rehabilitation center. Limited history was available.
Case 23. The patient was a middle-aged woman status post gastric bypass surgery (a Roux-en-Y procedure). The post-operative course was complicated by abdominal discomfort. The patient died suddenly.
Case 24. The patient was an elderly Latino man with a history of four-vessel coronary a. bypass (remote), insulin-requiring diabetes, and liver transplant (remote). He was in his usual state of health and working until approximately one year ago when he had back pain requiring surgery. The subsequent year was marked by concern for dementia, 70 lb. weight loss and admission to a nursing home. The patient had a witnessed sudden cardiopulmonary arrest and died.
Case 25. The patient was a middle-aged man with hypertension reportedly up to systolic 170 (diastolic unknown) who took a hypertensive medication but discontinued recently and was trying natural methods of blood pressure control. The patient was reportedly an experienced driver who used alcohol responsibly. He was riding his motorcycle, fell off and crashed at approximately 20 miles per hour (witnessed event) and was unresponsive when the paramedics arrived. Resuscitative measures were taken but the patient died at the scene. A brother died from a stroke in his 50’s.
Case 26. The patient was an elderly Caucasian woman with dementia who fell approximately one week prior to death. She sustained right facial and other right-sided injuries and was managed with pain medication. She died suddenly after a large bowel movement.
Case 27. The patient was a young African American woman with congenital, familial kidney disease requiring dialysis, status post two shunts (including a HeRO graft) and an arterio-venous fistula in the left arm. Each of these clotted. The patient developed pulmonary embolism (suspect origin: the clotted HeRO graft). When final shunt in the arm clotted, a temporary intravenous vascular site was inserted into the right neck prior to a new shunt being placed in the left thigh. For her pulmonary embolism, the patient was started on Coumadin and home oxygen. There was consideration of operative removal of clots. For unknown reasons, the patient’s Coumadin was discontinued approximately 6 months later. Approximately two months later, she became hypotensive and short of breath after a dialysis session and died despite resuscitative efforts.
Case 28. The patient was a middle-aged Latina woman with history of right lower leg pain she initially thought was an insect bite. On presenting for medical care, she was found have to peripheral vascular disease. She underwent a thrombectomy, endarterectomy and angioplasty of the right leg. The pain was mildly improved after the procedure. Five days postoperatively, she developed blisters and pain at the surgical site and was diagnosed with reperfusion syndrome. She was was discharged home still in considerable pain. She returned approximately 2 week later in severe, intolerable pain localized to the right lower leg. On admission, she was tachycardic. Vascular studies showed no change in flow patterns compared to immediately after the first operation. The patient had a second unspecified vascular procedure of the right leg during which she was tachycardic and hypertensive. Within several days post-operatively, she developed shortness of breath and died.
Case 29. The patient was a middle-aged Caucasian woman who had a respiratory infection approximately one month prior, during which time she developed left leg swelling. The patient died suddenly after an unwitnessed cardiopulmonary arrest.
Case 30. The patient was a middle-aged Caucasian man with alcoholism, atrial fibrillation, hypertension, status post coronary artery bypass surgery, pulmonary fibrosis (unknown etiology), cataract surgery complicated by detached retinas, arthritis, a skin condition with “fistulas,” and status post double knee replacement five years prior. Six weeks before death, he accidentally tore his left patellar tendon which was surgically repaired. The post-operative course was complicated by left foot ulceration and superior migration of the patella. The patient went for a post-operative clinic visit and was later that day found dead after an unwitnessed cardiopulmonary arrest.
Case 31. This was a second autopsy on a young African American man without prior medical issues.
Case 32. The patient was an elderly Caucasian woman with Alzheimer’s disease, status post abdominal hernia repair (remote), who underwent knee replacement surgery approximately one month prior. The family noted worsening mental status in the perioperative period. The patent was admitted to a nursing care facility. Over the next couple weeks, she was found difficult to rouse and had a witnessed cardiopulmonary arrest at the nursing facility. CPR was performed but the patient could not be revived. The family notes new administration of centrally acting agents during this time. The autopsy was performed three days after death. Whole blood postmortem toxicology showed ethyl alcohol, 0.049 gm/dl and lorazepam, 15.2 ng/ml.
Case 33. The patient was a middle-aged Caucasian man with hypertension and history of cardiac ablation one year prior for unspecified arrhythmia. He experienced the sudden onset of chest pain, presented to the emergency room and died eight hours later.
Case 34. The patient was an obese, elderly Caucasian woman with COPD who experienced sudden onset of shortness. She was found to have severe coronary a. disease by angiogram. She was deemed not a candidate for bypass surgery (due to her lung condition) and instead underwent coronary stent placement. After an unsuccessful attempt at placement through the left inguinal region, the stent was placed via the right inguinal region. The patient was stable in the immediate post-operative period, but later that day the nurse was unable to find a pulse in the right foot. The patient was agitated with some mental status changes. She was, per the physician, thought to be having an anxiety attack and was prescribed anti-anxiety medications. Throughout the evening, she remained somewhat confused. In the morning, she was found hypotensive. An angiographic procedure through the right arm identified bleeding from the right femoral a. catheter insertion site and an arterial patch was placed. The patient, however, could not be stabilized, required 10-15 units of blood over the next several hours, was intubated and died.
Case 35. The patient was a pre-adolescent African American elementary school student. He was in the back seat of a car during a single vehicle accident into a stationary object. The paramedics arrived. The patient was transferred to a local hospital where he received resuscitative efforts for an hour but died. The other three passengers, including the driver, received unspecified injuries requiring hospitalization but survived.
Case 36. The patient was a middle-aged Caucasian woman with past medical history of hiatal hernia, gastric ulcer (on Protonix for approximately 5 years and Mylanta) and deep venous thrombosis. She did not visit the doctor often. She had recent weight gain and knee pain; decreased activity and shortness of breath on exertion; and required elevation on pillows to sleep (for reflux, but possibly also for shortness of breath). The patient also had multiple episodes of unwitnessed syncope recently where she said she woke up after passing out in the bathroom. She was found dead after a family member could not enter her apartment and called police for a wellness check. She was found on a couch lying on her right side.
Case 37. The patient was an elderly Caucasian man with alcoholism and hypertension, status post coronary artery bypass graft surgery who had a pacemaker put in approximately two years prior. Approximately 6 months prior, the patient developed a metallic taste in the mouth, prompting him to have his water supply evaluated. Approximately 4 months prior, the patient went into renal failure, had a dialysis shunt put in and began dialysis. Approximately 3 months prior, he fell off a chair, was admitted and found to have bulging discs. During that admission, the pacemaker was found to be “corroded” and a temporary external pacemaker was placed. This was replaced by an internal pacemaker. The first pacemaker was removed, and the site debrided. The patient was transferred to rehab where he died suddenly two weeks later.
Case 38. The patient was a middle aged Caucasian man with a history of Crohn’s disease, obesity, sleep apnea, hypertension and medication-controlled atrial fibrillation who had an incidental right lower lobe lung mass identified on abdominal CT. Multiple biopsies were negative for maligancy, with the latest biopsy aborted due to technical difficulties. A presumptive diagnosis of cancer was made based on radiography. The patient underwent partial right lower lobectomy using the VATS procedure with right chest tube placement. In the immediate postoperative period, the patient developed atrial fibrillation with a rapid ventricular rate and was treated with amiodarone. Multiple x-rays showed bibasilar atelectasis; and the development of left upper lobe density. Pathology of the lung mass showed a necrotizing fungal granuloma. The patient was treated with IV antifungal medication and converted to oral antifungal medication. The patient was discharged home after approximately one week. At home, he had persistent diarrhea and diaphoresis for several days. He underwent cardiopulmonary arrest. Paramedics were called who performed CPR and administered epinephrine. He was brought into the emergency room and intubated. CT scan showed free air in the abdomen and gastric and right colic pneumatosis. The patient despite resuscitative efforts. (History to be updated.)
Case 39. The patient was a middle aged Latino man, recovering alcoholic with cirrhosis and esophageal varices (status post gastrointestinal bleed in somewhat recent past) and diabetes (diet controlled in past with recent addition of oral medication). During the prior three days, he participated in home improvement activities requiring exertion (carpentry, lifting). On the day of death, he began to complain of dizziness, sat down, was and offered something to drink and then passed out. A health professional was present and noted a slow pulse. Paramedics were called and the patient was brought to the emergency room. He was intubated and chest compressions were continued. An echocardiogram did not show any abnormality. The family was present and noted increased abdominal girth during resuscitation. Resuscitation was discontinued after one hour and the patient died. There was no history of slurred speech prior to his initial collapse.