Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Helwan University, Cairo, Egypt.
Faculty of Medicine, Helwan University, Cairo, Egypt.
Forensic Sci Med Pathol. 2024 Jun;20(2):387-399. doi: 10.1007/s12024-023-00609-2. Epub 2023 May 3.
Bone marrow embolism (BME) is likely a consequence of fractures in which pulmonary vessels are the most affected. However, some cases of BME were reported in the absence of trauma. Thus, a traumatic injury might not be necessary for developing BME. This study discusses BME cases in patients without signs of fractures or blunt trauma. The discussion addresses various possible mechanisms for the appearance of BME. Options include cancer in which bone marrow metastasis is a suggestive cause. Another proposal is the chemical theory where bone marrow fats are released via lipoprotein lipase in a pro-inflammatory state, resulting in vascular/pulmonary obstruction. Other cases discussed in this study are hypovolemic shock and drug-abuse related BME. All autopsy cases with BME were included regardless of the cause of death for a period of 2 years. Autopsies involved complete dissection with the macroscopic evaluation of the affected organs, including the heart, lungs, and brain. Tissues were also prepared for microscopic examination. Of the 11 cases, eight showed non-traumatic BME (72%). These findings conflict with theories in the literature that BME most commonly occurs after fractures or trauma. One of the eight cases exhibited mucinous carcinoma; one is presented with hepatocellular carcinoma; and two cases showed severe congestion. Lastly, one case was found to be associated with each of the following conditions: liposuction, drug abuse, pulmonary hypertension, and heart failure. Each case suggests a different pathophysiology for developing BME, yet the exact mechanisms are not fully understood. Further study of non-traumatic associated BME is recommended.
骨髓栓塞(BME)很可能是骨折的后果,其中肺部血管受影响最大。然而,也有一些 BME 的病例报告没有外伤。因此,创伤不一定是导致 BME 的原因。
本研究讨论了无骨折或钝性外伤迹象的患者的 BME 病例。讨论涉及 BME 出现的各种可能机制。包括骨髓转移是提示原因的癌症。另一种假设是化学理论,即骨骨髓脂肪在促炎状态下通过脂蛋白脂肪酶释放,导致血管/肺阻塞。本研究还讨论了其他病例,如低血容量性休克和与药物滥用相关的 BME。
在 2 年内,所有有 BME 的尸检病例均被纳入,无论死因如何。尸检包括完整的解剖,对受影响的器官(包括心脏、肺和大脑)进行宏观评估。还为显微镜检查准备了组织。
在 11 例中,有 8 例显示非外伤性 BME(72%)。这些发现与文献中的理论相矛盾,即 BME 最常发生在骨折或外伤后。其中 8 例中有 1 例表现为黏液癌;1 例为肝细胞癌;2 例显示严重充血。最后,1 例与吸脂术、药物滥用、肺动脉高压和心力衰竭各有一种情况相关。
每个病例都提示了不同的 BME 发病机制,但确切机制尚不完全清楚。建议进一步研究非外伤性相关的 BME。
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