Sudden Unexpected Death During Bronchoscopy of a Patient with Pulmonary Lymphangitic Carcinomatosis and Pulmonary Tumor Thrombotic Microangiopathy due to Gastric Cancer
박소형, 나주영, 최병하,
소속 상세정보
박소형 ( Park So-Hyung )
National Forensic Service Medical Examiner’s Office
나주영 ( Na Joo-Young )
Pusan National University Yangsan Hospital Department of Pathology
최병하 ( Choi Byung-Ha )
National Forensic Service Seoul Institute Division of Forensic Investigation
Abstract
We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.
키워드
Forensic pathology; Autopsy; Postmortem; Lymphatic carcinomatosis; Stomach neoplasms; Pulmonary tumor thrombotic microangiopathy
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