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Hayakawa A, Sano R, Takahashi Y, Fukuda H, Okawa T, Kubo R, Takei H, Komatsu T, Tokue H, Sawada Y, Oshima K, Horioka K, Kominato Y. Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery. J Forensic Leg Med 2023; 93:102474. [PMID: 36577210 DOI: 10.1016/j.jflm.2022.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/27/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
A woman in her 80s was found unconscious after being hit by a car while crossing a road. After admission to hospitals, computed tomography (CT) scans revealed traumatic brain injury (TBI), and the patient was treated symptomatically. However, despite improvement of TBI in CT images, she died unexpectedly. Postmortem CT demonstrated cerebral infarction in the territory of the right middle cerebral artery (MCA). Histopathological examination revealed lumen-obstructing thrombosis and intimal injury upstream of the thrombosis in the right MCA. These findings suggested that the intimal injury in the MCA had led to thrombus formation, and thromboembolism in the region distal to the injury leading to post-traumatic cerebral infarction (PTCI). Both postmortem CT and autopsy were able to reveal the final condition of the deceased, which had not been fully anticipated by the clinicians who had treated her after the accident. The longitudinal antemortem to postmortem course revealed by multiple CT images and the histopathological examination provided crucial clues to the pathogenesis of PTCI in this case.
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Affiliation(s)
- Akira Hayakawa
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 171 77, Sweden.
| | - Rie Sano
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Haruki Fukuda
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Takafumi Okawa
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Hiroyuki Takei
- Department of Radiology, Tsukuba International University, Tsukuba, 300-0051, Japan
| | - Takakazu Komatsu
- Department of Diagnostic Radiology & Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Kie Horioka
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 171 77, Sweden; Department of Forensic Medicine, Research Unit of Internal Medicine, University of Oulu, Oulu, 90014, Finland
| | - Yoshihiko Kominato
- Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
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Colboc H, Bazin D, Reguer S, Lucas IT, Moguelet P, Amode R, Jouanneau C, Soria A, Chasset F, Amsler E, Pecquet C, Aractingi S, Bellot-Gurlet L, Deschamps L, Descamps V, Kluger N. Chemical characterization of inks in skin reactions to tattoo. JOURNAL OF SYNCHROTRON RADIATION 2022; 29:1436-1445. [PMID: 36345752 PMCID: PMC9641572 DOI: 10.1107/s1600577522008165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.
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Affiliation(s)
- Hester Colboc
- Sorbonne Université, Hôpital Rothschild, Service de Gériatrie-Plaies et Cicatrisation, Paris, France
- Sorbonne Université, UPMC Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, F-75020 Paris, France
| | - Dominique Bazin
- Institut de Chimie Physique, Université Paris-Saclay, Orsay, France
| | - Solenn Reguer
- DiffAbs Beamline, Synchrotron SOLEIL, L’Orme des Merisiers, Départementale 128, 91190 Saint-Aubin, France
| | - Ivan T. Lucas
- Sorbonne Université, CNRS, Laboratoire Lise UMR 8235, Paris, France
| | - Philippe Moguelet
- Sorbonne Université, Hôpital Tenon, Anatomie et Cytologie Pathologiques, Paris, France
| | | | - Chantal Jouanneau
- Sorbonne Université, UPMC Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, F-75020 Paris, France
| | - Angèle Soria
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - François Chasset
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Emmanuelle Amsler
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Catherine Pecquet
- Sorbonne Université, Hôpital Tenon, Service de Dermatologie-Allergologie, Paris, France
| | - Sélim Aractingi
- Université de Paris, Hôpital Cochin, Service de Dermatologie, Paris, France
| | | | - Lydia Deschamps
- Université de Paris, Hôpital Bichat, Service d’Anatomie et Cytologie Pathologique, Paris, France
| | - Vincent Descamps
- Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
| | - Nicolas Kluger
- Université de Paris, Hôpital Bichat, Service de Dermatologie, Paris, France
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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3
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Jung J, Peters G, Donovan S, Peters G. Tattoo Pigment in an Intramammary Lymph Node Mimicking Breast Malignancy. Cureus 2022; 14:e30336. [PMID: 36407269 PMCID: PMC9663708 DOI: 10.7759/cureus.30336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
There are many patterns of microcalcification in mammography. Distinguishing between these patterns can be challenging. A malignant cause needs to be assessed through further diagnostic workup. We present a case of a 36-year-old BRCA1 mutation carrier, presenting with a small mass containing calcification on her screening mammogram. A vacuum-assisted biopsy under tomosynthesis guidance was performed and demonstrated an intramammary lymph node showing prominent extracellular black pigment. To our knowledge, this is the first case report of tattoo pigment mimicking breast malignancy on mammography.
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Heaney RM, Sweeney L, Smith C, O'Brien A. Much 'tattoo' about nothing; Tattoo pigment mimicking breast microcalcifications on mammography. Radiol Case Rep 2021; 16:1833-1835. [PMID: 34040686 PMCID: PMC8141413 DOI: 10.1016/j.radcr.2021.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
Mimics of calcifications on mammography are not uncommon and result in additional investigations that can cause patient anxiety. We describe the case of a 63 year old male who underwent further investigation of calcifications in the superior right breast. Additional imaging and patient examination revealed that the calcifications were located in a color tattoo overlying the medial right pectoralis muscle and actually represented the radio-opaque metallic compounds found in tattoo pigment.
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Affiliation(s)
- Roisin M Heaney
- Breast Health, Mater Misericordiae University Hospital, 38 Eccles Street, Dublin 7, Ireland
| | - Laura Sweeney
- Breast Health, Mater Misericordiae University Hospital, 38 Eccles Street, Dublin 7, Ireland
| | - Clare Smith
- Breast Health, Mater Misericordiae University Hospital, 38 Eccles Street, Dublin 7, Ireland
| | - Angela O'Brien
- Breast Health, Mater Misericordiae University Hospital, 38 Eccles Street, Dublin 7, Ireland
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Paul Litton T, Vijay Ghate S. Tattoo pigment mimicking axillary lymph node calcifications on mammography. Radiol Case Rep 2020; 15:1194-1196. [PMID: 32550957 PMCID: PMC7292895 DOI: 10.1016/j.radcr.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Axillary lymph nodes can appear abnormal on mammography due to uptake of tattoo pigment and a malignant cause must be excluded through diagnostic workup. Furthermore, tattoo pigment can mimic malignant pathology at surgery or confound appropriate staging of breast cancer. We present the case of a 47-year-old female with left axillary lymph nodes demonstrating new coarse densities suspicious for malignant calcifications on screening mammogram. Stereotactic guided biopsy was performed which demonstrated pigment from a recent tattoo located on the patient's back and/or flank. Awareness of current or prior tattoos in a patient is helpful to properly manage such cases.
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Affiliation(s)
- Tyler Paul Litton
- Northwestern Medicine Department of Radiology, 676 North Saint Clair Street Suite 800 Chicago, IL 60611 USA
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