Adjunct Associate Professor Sarah Parsons, Prof Richard Bassed, Melbourbe, VIC, Australia.
Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourbe, VIC, Australia.
Cardiovasc Pathol. 2023 Jan-Feb;62:107476. doi: 10.1016/j.carpath.2022.107476. Epub 2022 Sep 16.
Diagnosis of myocarditis as the cause of death in the forensic setting at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is often non-reproducible. The primary aim of this study was to investigate the differences in the amount of inflammation between cases where myocarditis was deemed the cause of death, compared to cases where myocardial inflammation was incidentally present at autopsy, but not determined to be the cause of death. Participants were sourced from the Victorian Institute of Forensic Medicine (VIFM) database, from full autopsies conducted on reportable death in Victoria, Australia between the years 2011 and 2021. Cases of fatal myocarditis were significantly more likely to experience infection-like symptoms prior to death, and to be in hospital at the time of death. Histopathological examination revealed fatal cases had a significantly higher inflammatory index compared to the incidental group. Lethal cases were also significantly more likely to have myocyte necrosis, and a diffuse pattern of inflammation. There are significant differences between cases where myocardial inflammation has been determined to be the cause of death and cases where inflammation in the myocardium was an incidental finding. These results could be used in the forensic autopsy to help pathologists determine if inflammation should be considered fatal or incidental.
在法医尸检中，目前由法医病理学家诊断心肌炎是否为死亡原因。目前尚无系统的诊断方法，因此该判定易受观察者间差异的影响，且通常不可重现。本研究的主要目的是调查在判定心肌炎为死亡原因的病例与尸检时偶然发现心肌炎症但未判定为死亡原因的病例之间，炎症程度的差异。参与者来自维多利亚法医研究所（VIFM）数据库，这些病例来自 2011 年至 2021 年期间澳大利亚维多利亚州报告死亡的全面尸检。致命性心肌炎病例在死亡前更有可能出现类似感染的症状，且在死亡时更有可能在医院。组织病理学检查显示，致命病例的炎症指数明显高于偶然组。致命病例也更有可能出现心肌细胞坏死和弥漫性炎症。在已判定心肌炎症为死亡原因的病例与心肌炎症为偶然发现的病例之间存在显著差异。这些结果可用于法医尸检，以帮助病理学家确定炎症是否应被视为致命性或偶发性。
