Fineschi Vittorio, Turillazzi Emanuela, Neri Margherita, Pomara Cristoforo, Riezzo Irene
Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy.
Forensic Sci Int. 2009 Apr 15;186(1-3):22-8. doi: 10.1016/j.forsciint.2009.01.006. Epub 2009 Feb 8.
The histological age determination of venous thromboses in fatal pulmonary embolism cases is an important task of forensic medicine and requires thorough knowledge of the general and specific pathology of pulmonary thromboembolism (PTE). The aim of our investigation was to carry out a chronological evaluation of the deep venous thrombosis (DVT) phenomenon, to assess the chronological transformation of the thrombus and to determine the causal relationship with PTE as cause of death. The clinical data and the autopsy records of the 2843 autopsies performed over the period 1 November 1998 to 31 December 2007 were retrospectively evaluated, and 140 cases in which PTE was pointed out as cause of death were selected. The dissection of the deep veins of the legs has been performed systematically to search for the starting point of venous embolism. 4.5% of pulmonary embolisms originated in the in iliac veins, 20.7% in the femoral veins, and 74.8% in the deep crural veins. In the venous sites of thrombosis, the histological assessment has been performed in conjunction with the surrounding vascular wall of uncut blood vessel with at least three to six different transverse incisions. Histological assessment of the embolus samples was also performed in conjunction with the venous sites of thrombosis. In our selected 140 cases of PTE, the DVT was classified as phase 1 in 48 cases (34.29%), as phase 2 in 70 cases (50%), and 22 cases (15.71%) were evaluated as older than 2 months (phase 3). The observed transformation of the thrombus by organization is suitable for a forensically utilizable age determination. However, only three chronological stages can be distinguished with any degree of certainty using immunohistochemistry and CLSM.
在致命性肺栓塞病例中，确定静脉血栓形成的组织学年龄是法医学的一项重要任务，需要全面了解肺血栓栓塞症（PTE）的一般病理学和特殊病理学知识。我们研究的目的是对深静脉血栓形成（DVT）现象进行时间顺序评估，评估血栓的时间演变，并确定其与作为死亡原因的PTE之间的因果关系。回顾性评估了1998年11月1日至2007年12月31日期间进行的2843例尸检的临床资料和尸检记录，选择了140例指出PTE为死亡原因的病例。系统地解剖了腿部深静脉，以寻找静脉栓塞的起始点。4.5%的肺栓塞起源于髂静脉，20.7%起源于股静脉，74.8%起源于小腿深静脉。在血栓形成的静脉部位，结合未切开血管的周围血管壁，进行了至少三到六个不同横切口的组织学评估。还结合血栓形成的静脉部位对栓子样本进行了组织学评估。在我们选择的140例PTE病例中，48例（34.29%）的DVT被分类为1期，70例（50%）为2期，22例（15.71%）被评估为超过2个月（3期）。观察到的血栓通过机化的转变适用于法医学上可利用的年龄确定。然而，使用免疫组织化学和共聚焦激光扫描显微镜（CLSM）只能确定区分三个时间阶段。
