Lecomte D, Fornes P, Fouret P, Nicolas G
Department of Forensic Medicine, Institut Médico-Légal de Paris, France.
J Forensic Sci. 1993 May;38(3):617-21.
In performing medicolegal autopsies on sudden deaths, there occur a number of cases in which no cause of death can be found. In particular, no evidence of macroscopic cardiac abnormalities can be observed. However, extensive histological screening may reveal isolated areas of myocardial fibrosis. The five cases presented discuss the etiology of this fibrosis and its possible relation to myocarditis. The cases involve white women between the ages of 19 and 25 with no previous medical history. The weight of the heart in all five cases was normal. Macroscopic evidence of fibrosis was visible in four out of five cases. No other macroscopic abnormalities were observed. Histologically, there was evidence of scarring or interstitial fibrosis in all five cases. In four of the cases, additional screening permitted the observation of dispersed inflammatory foci consisting of lymphocytes, plasmocytes and macrophages. Two of the cases demonstrated eosinophil and neutrophil aggregates in the center of necrotic foci. No evidence of vascular inflammatory phenomena was observed in any of the five cases. According to the Dallas criteria, three of the five cases fulfill the requirements for myocarditis and one of the five cases for borderline myocarditis. The Dallas criteria, however, do not take into consideration the possible association between inflammation and myocardial fibrosis since many of the reported series of myocarditis have been from hospital autopsies or endomyocardial biopsies and have not taken into account sudden death from fibrotic sequelae of myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)
在对猝死病例进行法医尸检时，会出现许多无法找到死因的情况。特别是，未观察到宏观心脏异常的证据。然而，广泛的组织学筛查可能会发现心肌纤维化的孤立区域。本文呈现的5例病例探讨了这种纤维化的病因及其与心肌炎的可能关系。这些病例涉及年龄在19至25岁之间且无既往病史的白人女性。所有5例病例的心脏重量均正常。5例中有4例可见纤维化的宏观证据。未观察到其他宏观异常。组织学上，所有5例病例均有瘢痕形成或间质纤维化的证据。其中4例病例，进一步筛查发现有由淋巴细胞、浆细胞和巨噬细胞组成的散在炎症灶。2例病例在坏死灶中心可见嗜酸性粒细胞和中性粒细胞聚集。5例病例中均未观察到血管炎症现象的证据。根据达拉斯标准，5例中有3例符合心肌炎的诊断标准，5例中有1例符合临界性心肌炎的诊断标准。然而，达拉斯标准未考虑炎症与心肌纤维化之间的可能关联，因为许多已报道的心肌炎系列病例来自医院尸检或心内膜心肌活检，未考虑心肌炎纤维化后遗症导致的猝死情况。（摘要截选于250字）
