Dominicis Enrico De, Marella Gian Luca, Giuga Gabriele, Ceccobelli Giulia, Savino Luca, Tavone Alessandro Mauro
ASL Frosinone, UOC Medicina Legale Territoriale, Frosinone, Lazio, Italy.
University of Rome Tor Vergata, Department of Surgical Sciences, Rome, Italy.
Autops Case Rep. 2024 Mar 15;14:e2024482. doi: 10.4322/acr.2024.482. eCollection 2024.
The present work reports the autopsy findings of a unique case characterized by fatal retroperitoneal hemorrhage following the traumatic rupture of bilateral renal angiomyolipomas. Renal angiomyolipomas are generally benign tumors with an unpredictable clinical course, ranging from asymptomatic to sudden rupture and hemorrhagic shock. They may be associated with genetic disorders such as tuberous sclerosis complex. The case under investigation is unprecedented in the medical literature due to its bilateral nature and fatal outcome. Autopsy analysis revealed an extensive retroperitoneal hemorrhage originating from bilateral ruptured tumors. Microscopic examination found features consistent with bilateral renal angiomyolipoma. Circumstantial information identified a traffic accident before the death, considering it as the cause of the tumors' traumatic rupture. In this case, due to the severity of the situation, immediate medical measures-such as fluid resuscitation, coagulopathy correction, and surgical treatment, which are usually lifesaving-could not be performed. This led to the patient being declared dead at the scene of the crash.
本研究报告了一例独特病例的尸检结果,该病例特征为双侧肾血管平滑肌脂肪瘤创伤性破裂后发生致命性腹膜后出血。肾血管平滑肌脂肪瘤通常为良性肿瘤,临床病程不可预测,从无症状到突然破裂和出血性休克不等。它们可能与结节性硬化症等遗传疾病有关。该病例因双侧性和致命结局在医学文献中尚无先例。尸检分析显示广泛的腹膜后出血源自双侧破裂的肿瘤。显微镜检查发现符合双侧肾血管平滑肌脂肪瘤的特征。间接信息确定死亡前发生了交通事故,认为这是肿瘤创伤性破裂的原因。在该病例中,由于情况严重,通常可挽救生命的即时医疗措施,如液体复苏、凝血障碍纠正和手术治疗,无法实施。这导致患者在车祸现场被宣布死亡。