Ben Jomaa Sami, Haj Salem Nidhal, Njima Manel, Zakhama Abdelfattah, Chadly Ali
Department of Forensic Medicine - Teaching Hospital of Monastir (Tunisia) - Faculty of Medicine, Tunisia.
Department of Pathology - Teaching Hospital of Monastir (Tunisia) - Faculty of Medicine, Tunisia.
J Forensic Leg Med. 2020 Apr;71:101934. doi: 10.1016/j.jflm.2020.101934. Epub 2020 Feb 29.
In this paper, we report two rare cases of sudden death due to giant left ventricular thrombus revealed at autopsy and we discuss the manner and the cause of death.
Cases presentation: The two cases reported are about two men aged 55 and 53 years respectively. In the two cases, no past cardiac history was found. Prior to the onset of complications and subsequent death, both patients presented to the emergency department with progressing asthenia, faintness and shortness of breath, were treated symptomatically. At autopsy, atherosclerosis of coronary arteries was found. In the first case, death was attributed to thrombosis of the pseudoaneurysm. In the second case, it was due to thrombosis complicating a myocardial infarction. The mechanism of death in the first case was explained by the hemodynamic shock caused by a total left ventricular pseudoaneurysm thrombosis secondary to old myocardial infraction. In the second case, death was the consequence of a cardiogenic shock secondary to thrombosis of the cardiac pseudoaneurysm complicating a myocardial infraction.
Complications of myocardial infarction represent frequent causes of adult sudden death. Left ventricular thrombosis is a complication that is often fatal and its discovery during an autopsy remains rare. The first-line doctor must take these types of complications into consideration in order to detect them and thus ensure timely management.
在本文中,我们报告两例经尸检发现的因巨大左心室血栓导致猝死的罕见病例,并讨论死亡方式和原因。
病例介绍:所报告的两例病例分别为两名55岁和53岁的男性。两例患者均无既往心脏病史。在并发症发作及随后死亡之前,两名患者均因进行性乏力、头晕和呼吸急促前往急诊科就诊,并接受了对症治疗。尸检发现冠状动脉粥样硬化。在第一例中,死亡归因于假性动脉瘤血栓形成。在第二例中,死亡是由于心肌梗死并发血栓形成所致。第一例的死亡机制是陈旧性心肌梗死继发左心室假性动脉瘤完全血栓形成导致的血流动力学休克。在第二例中,死亡是心肌梗死并发心脏假性动脉瘤血栓形成继发心源性休克的结果。
心肌梗死并发症是成人猝死的常见原因。左心室血栓形成是一种常致命的并发症,在尸检中发现仍然罕见。一线医生必须考虑到这类并发症以便能够发现它们,从而确保及时处理。