Skeletal muscle coronary embolism: a complication of coronary angiography

Skeletal muscle and fatty tissue in mixed pulmonary embolism associated with liposuction: An incidental autopsy finding

Nonthrombotic pulmonary embolism is an uncommon life-threatening complication following liposuction. We report a rare incidental autopsy finding associated with this procedure. A 43-year-old female who underwent liposuction presented with hypotension, respiratory distress, loss of consciousness and cardiorespiratory arrest during the intraoperative period. The patient died 2 h after admission to the emergency department. Autopsy reported a massive hemoperitoneum (2.2 L) secondary to liver perforation associated with liposuction as the cause of death. Pelvic, umbilical and lumbar peritoneal perforations were also observed. The histological study showed segments of the pulmonary arteries occluded by mixed emboli of skeletal muscle fibers coexisting with fatty tissue. We discuss the origin, pathophysiology and clinical manifestations of this new kind of mixed pulmonary embolism.

Myocardial tissue embolism in lung due to gunshot wound to the chest

Myocardial tissue embolism due to gunshot wound is a very rare event, as only a few cases of myocardial tissue embolization, occurring after cardiac surgery or myocardial infarction, have been reported. According to this study's referenced report from forensic autopsy, one case of myocardial tissue emboli to the lung has been found, in an Asian male, 22 years old, who died from a gunshot to the chest by a handgun. From the examination, myocardial tissue embolism was considered important forensic evidence, showing that the gunshot occurred while the victim was still alive, and that he also survived for some period of time after being shot.

The deliberate killing of a sheep with a fire extinguisher: a case report and experimental reconstruction study

The morphological findings of a sheep deliberately killed with a powder fire extinguisher in an act of cruelty are described. The animal was orally insufflated with the powder of a 6 kg fire extinguisher having the working pressure of 15 bar. This led to rupture of the esophagus and rumen, followed by rupturing of the abdominal wall. Furthermore, powder was applied rectally into the large intestine and vaginally into the genital tract. For a better understanding of the lesion patterns and of the course of events, fire extinguishers were used in an experimental case reconstruction study on sheep carcasses. Rupture of the rumen and abdominal wall could only be reproduced after intraesophageal insufflation but not after oral insufflation. Therefore, an esophageal application has to be considered in the killed sheep. Esophageal rupture in sheep carcasses could not be reproduced by oral or by esophageal application of the fire extinguisher. Nevertheless, in isolated fresh ovine esophagi, compressed air of less than 1 bar was sufficient to induce tissue separation in the esophageal wall. The described case reveals parallels with findings in rarely reported accidents with or in suicides committed with chemical fire extinguishers.

Coronary Embolism and Myocardial Infarction: A Scoping Study

Coronary embolism is a cause of acute myocardial infarction (AMI)in which obstructive foci enter the coronary circulation, block normal blood flow and precipitate ischemia. Precise studies focusing on patient population affected, pathophysiological mechanisms, and treatment strategies are scanty, in spite of a reported prevalence estimated at 2.9%. As the understanding of myocardial infarction without evidence of coronary artery disease continues to grow, an in-depth review of this previously seldomly reported subtype of coronary ischemia was in order. Patients suffering coronary embolism are 15 to 20 years younger than traditional AMI patients with a slight predominance towards male sex, which resembles the gender data of the populations affected by non-traditional myocardial infarction in published reports. While the expected prevalence rate of cardiovascular disease risk factors such as hypertension and hyperlipidemia are present, this population also has a relatively high prevalence of atrial fibrillation and valve pathology, especially endocarditis. Initial presentation is indistinguishable from other causes of myocardial infarction however fever is commonly present, when endocarditis with valvular involvement is the primary cause of the coronary embolism. Mechanical thrombectomy is the mainstay of treatment, followed by percutaneous coronary intervention. Mortality is the highest in patients who do not receive targeted treatment for the coronary embolism, particularly if only antimicrobial agents or anticoagulation without thrombolytic agents are employed. The unique features of coronary embolism highlighted in this historical study justify further examination in contemporary patient populations.

Livedo reticularis due to multiple cholesterol emboli

Three patients with advanced atherosclerotic vascular disease developed multiple cholesterol emboli. The clinical presentation typically includes livedo reticularis of the lower part of the body and purple toes. Small areas of necrosis and ulceration may be present distally, despite palpable pulses. Muscular and abdominal pain, as well as alterations in renal function, may also occur. Cutaneous biopsy reveals characteristic cholesterol clefts within atheromatous debris filling small, deep arterial lumen. Pathophysiologic mechanisms are discussed.

Catheter fragmentation: a potential source of catheter embolus

Aortic root angiography in the patient described in the present report was complicated by precipitious catheter occlusion. Analysis of the occluding fragment by infrared spectroscopy indicated that it was a urethane structure, suggesting that the occluding fragment resulted from spontaneous fragmentation of the polyurethane catheter. Experience with this patient thus documents the potential for nonblood catheter embolus.