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PubMed2004

Cardiovascular malformations and sudden death in infancy.

BACKGROUND: We survey the postmortem findings of cardiovascular malformations in infants under the age of 1 year who died suddenly and unexpectedly, in a way that mimicked sudden infant death syndrome (SIDS), and evaluate the importance of the malformation for the fatal outcome. METHODS: Four hundred fifty-seven infants under the age of 1 year, who died between 1982 and 2001, were investigated at the Department of Forensic Medicine in Stockholm, Sweden. RESULTS: Cardiovascular malformations were found in 18 infants (3.9%). Only 6 of 18 malformations, mostly severe, were clinically diagnosed before death. In the other 12 infants, cardiovascular malformations were found, such as atrial or ventricular septal defects, coarctation of aorta, stenosis of the aortic or pulmonary artery orifice, and aneurysm of the membranous portion of the interventricular septum. In all instances, the heart weight was increased. CONCLUSIONS: The observation of undiagnosed cardiovascular malformations as the only explanation for the cause of sudden and unexpected death in apparently healthy infants may advocate more examinations of the infant during early life. It is also important to enlarge the debate of the cause of death in infants with cardiovascular malformations. Should they be included in borderline SIDS?

Diagnosis, Differential↗
PubMed2003

Fluorodeoxyglucose positron emission tomography excludes pericardial metastasis by recurrent lung cancer.

Fluorodeoxyglucose (FDG) positron emission tomography (PET) has been shown to be useful in the diagnosis and staging of a variety of malignancies. Because of its high sensitivity, FDG PET frequently detects malignant lesions that are not demonstrated clearly by anatomic imaging modalities. FDG PET usually has high negative predictive value and, therefore, negative studies are highly suggestive of a benign process. The authors present a patient in whom transesophageal echocardiography and magnetic resonance imaging described pericardial metastasis from a recurrent lung cancer, which on FDG PET was shown correctly to suggest benign scar tissue.

Carcinoma, Small Cell↗
PubMed1985

Dilated (congestive) cardiomyopathy: a syndrome of severe cardiac dysfunction with remarkably few morphological features of myocardial damage.

A review of 76 endomyocardial biopsies and 54 autopsies of patients with dilated cardiomyopathy (DCM) revealed features of hypertrophy and degenerative changes associated with long-standing hypertrophy. Long-term survivors had significantly heavier heart weights. Short-term survivors had heavier than normal right ventricular weights. No pathological findings supportive of a previous viral myocarditis, persistent slow virus infection or autoimmune process were observed. Hearts of autopsied DCM patients showed no significant difference from controls with regard to interstitial mononuclear cells. Morphometry failed to detect any difference in the fibrous tissue component between the DCM and control patients. Microscopic findings suggest that the cardiac failure of DCM is due to a potentially reversible functional abnormality. The cause of this is unknown, but the morphology suggests that future research should be directed by the premise that DCM represents a toxic-metabolic defect-deficiency state.

Cardiomegaly↗
PubMed1981

Heart weights among octogenarians.

The weights of hearts among 110 octogenarians were studied. At autopsy they ranged from 174 to 785 gm, which is more than the customary norm for adults. In only 15 subjects were the hearts considered completely normal. Other hearts showed hypertrophy, friable muscle, fatty infiltration, brown atrophy, a flabby myocardium, valvular changes, and atheroma or calcification of the coronary arteries. The frequency of these changes and their relationship to heart weight are discussed. A previous study of heart weights among 39 nonagenarians had shown weights ranging from 159 to 539 gm --- somewhat less than those among the octogenarians. Heavy heart weights are common in these two age groups.

Aged↗