Collins Kim A, Presnell S Erin
Department of Pathology and Laboratory Medicine, Forensic and Autopsy Pathology, Medical University of South Carolina, Charleston, 29425, USA.
Am J Forensic Med Pathol. 2005 Dec;26(4):327-9. doi: 10.1097/01.paf.0000188078.43884.77.
Asphyxia secondary to airway obstruction has numerous underlying causes, both acute and chronic. Causes of chronic airway obstruction, such as neoplasms and tracheal scarring, are often clinically apparent well prior to asphyxia. Causes of acute airway obstruction may not be as obvious to clinicians or investigators. These include infections, anaphylactic reactions, status asthmaticus, inhalational injuries, and aspirations, which may result in acute obstruction and sudden death. We report the deaths of 2 individuals, a 43-year-old female and a 78-year-old female, both with adenocarcinoma. The 43-year-old was hospitalized with a stage III, poorly differentiated infiltrating ductal carcinoma of the breast metastatic to the lymph nodes. She was intubated to treat poor respiratory function and acidosis. A bronchoalveolar lavage was consistent with alveolar hemorrhage; no organisms were identified. Blood and "clot" were in her endotracheal tube, so the endotracheal tube was replaced. She became comatose and life support was withdrawn. At autopsy, a large red-gray thrombus obstructed the trachea and extended into the right bronchus. Microscopically, the entire clot was composed of fibrin, red blood cells, and some mucus. Findings of acute respiratory distress syndrome with hyaline membranes were identified. The cause of death was listed as acute respiratory distress syndrome with tracheobronchial thrombus. Experiencing a decline in mental status, the 78-year-old had metastatic adenocarcinoma of unknown primary. She developed sudden respiratory distress and an airway obstruction was discovered. After failure to relieve the obstruction, she decompensated and died. At autopsy, a large, red-gray thrombus obstructed the distal trachea and both bronchi. Microscopically, the thrombus was composed of fibrin, platelets, and red blood cells. The cause of death was asphyxia secondary to airway obstruction by thrombus. We present these 2 unusual cases of asphyxia and review of the literature focusing on asphyxia and the etiology of airway thrombi.
气道阻塞继发的窒息有许多潜在病因，包括急性和慢性病因。慢性气道阻塞的病因，如肿瘤和气管瘢痕形成，通常在窒息发生之前在临床上就已很明显。急性气道阻塞的病因对临床医生或研究人员来说可能不那么明显。这些病因包括感染、过敏反应、哮喘持续状态、吸入性损伤和误吸，它们可能导致急性阻塞和猝死。我们报告了2例死亡病例，1名43岁女性和1名78岁女性，均患有腺癌。43岁女性因III期低分化浸润性乳腺导管癌伴淋巴结转移住院。她因呼吸功能差和酸中毒而插管治疗。支气管肺泡灌洗结果与肺泡出血一致；未发现病原体。气管内有血液和“血块”，因此更换了气管插管。她陷入昏迷，随后停止了生命支持。尸检时，一个大的红灰色血栓阻塞了气管并延伸至右支气管。显微镜下，整个血栓由纤维蛋白、红细胞和一些黏液组成。发现有急性呼吸窘迫综合征伴透明膜形成。死亡原因列为急性呼吸窘迫综合征伴气管支气管血栓形成。78岁女性因原发灶不明的转移性腺癌出现精神状态下降。她突然出现呼吸窘迫，发现气道阻塞。在未能解除阻塞后，她病情恶化并死亡。尸检时，一个大的红灰色血栓阻塞了气管远端和双侧支气管。显微镜下，血栓由纤维蛋白、血小板和红细胞组成。死亡原因是血栓导致气道阻塞继发窒息。我们呈现这2例不寻常的窒息病例，并对有关窒息和气道血栓形成病因的文献进行综述。
