A Sudden Infant Death Due to Congenital Diaphragmatic Hernia

Unlocking the Role of sMyBP-C: A Key Player in Skeletal Muscle Development and Growth

Skeletal muscle is the largest organ in the body, responsible for gross movement and metabolic regulation. Recently, variants in the MYBPC1 gene have been implicated in a variety of developmental muscle diseases, such as distal arthrogryposis. How MYBPC1 variants cause disease is not well understood. Here, through a collection of novel gene-edited mouse models, we define a critical role for slow myosin binding protein-C (sMyBP-C), encoded by MYBPC1, across muscle development, growth, and maintenance during prenatal, perinatal, postnatal and adult stages. Specifically, Mybpc1 knockout mice exhibited early postnatal lethality and impaired skeletal muscle formation and structure, skeletal deformity, and respiratory failure. Moreover, a conditional knockout of Mybpc1 in perinatal, postnatal and adult stages demonstrates impaired postnatal muscle growth and function secondary to disrupted actomyosin interaction and sarcomere structural integrity. These findings confirm the essential role of sMyBP-C in skeletal muscle and reveal specific functions in both prenatal embryonic musculoskeletal development and postnatal muscle growth and function.

Death by late presenting of diaphragmatic hernia in an infant: case report and review of the literature

Background

Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm, resulting in the herniation of the abdominal organs into the thoracic cavity. If not properly diagnosed before or at birth, CDH represents a life-threatening pathology in infants and a major cause of death. We present a fatal case of congenital diaphragmatic hernia corresponding to Bochdalek hernia, discovered incidentally during a sudden death’s autopsy of an infant. To achieve a better view of the range of these anomalies, we also conducted a literature review on this subject describing the pathogenesis, manifestations, diagnosis, and autopsy contribution to addressing these CDH.

Case presentation

The case involved a 4-month-old female infant who presented sudden respiratory difficulties after breastfeeding. External examination found marked cyanosis with no evidence of trauma. Upon opening the chest cavity, the stomach, markedly distended, was occupying much of the left pleural cavity. The left lung was compressed and displaced superiorly, and the heart was also compressed and deviated to the right. This mediastinal deviation was due to an ascension of the stomach into the chest cavity through a 2 × 1.5 cm defect in the posterior left hemidiaphragm. Further examination remarked an ecchymotic appearance of the stomach portion entrapped in the hernia defect suggesting recent strangulation of the stomach. The lungs showed atelectasis with signs of pulmonary infection in the histology study.

Conclusions

CDH might be considered uncommon and not always mentioned in the list of sudden death in infant causes. Forensic pathologists should know of this malformation in order to apply the best autopsy techniques and thus allow positive feedback to pediatricians considering the possible legal implications.

Sudden death after being in a bounce house: a late complication of congenital diaphragmatic hernia

A 3-year-old white female with no significant past medical history was found unresponsive and apneic after several hours of vomiting. The patient had reportedly felt unwell since jumping in a bounce house at a festival earlier in the day. After one hour of attempted resuscitation by EMS and hospital staff, the patient was pronounced deceased. On autopsy there was a 3 cm opening in the left posterolateral hemidiaphragm with the spleen, the stomach, and portions of the small and large bowel displaced into the left chest cavity, resulting in compression of both lungs and the heart to the right side of the chest. The right lung weighed 295 g while the left lung weighed 73 g. Histologic examination revealed atelectasis in the left lung and congestion in the right lung, the spleen, the stomach, and the bowel. The cause of death was ultimately ruled to be respiratory compromise and associated gastrointestinal complications due to diaphragmatic herniation of abdominal contents into the chest cavity. It is hypothesized that herniation occurred in this case secondary to increased intra-abdominal pressure from jumping in a bounce house, an etiology that we were unable to find elsewhere despite a thorough literature search.