Acute or chronic pulmonary emphysema? Or both?-A contribution to the diagnosis of death due to violent asphyxiation in cases with pre-existing chronic emphysema
| Autor: | Timm J. Filler, Giuseppe Gava, Stefanie Ritz-Timme, Simon B. Eickhoff, Felix Mayer, Nina Sophia Mahlke |
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| Rok vydání: | 2020 |
| Předmět: |
Emphysema
Pathology medicine.medical_specialty Multivariate analysis Chronic emphysema business.industry Pulmonary emphysema Alveolar septum Autopsy Pathology and Forensic Medicine Asphyxia Pulmonary Emphysema Immunohistochemistry Medicine Humans ddc:610 Analysis of variance Medical diagnosis business Lung |
| Zdroj: | International journal of legal medicine 136, 133–147 (2022). doi:10.1007/s00414-021-02619-7 |
| ISSN: | 1437-1596 |
| Popis: | The diagnosis of death due to violent asphyxiation may be challenging if external injuries are missing, and a typical acute emphysema (AE) “disappears” in pre-existing chronic emphysema (CE). Eighty-four autopsy cases were systematically investigated to identify a (histo-) morphological or immunohistochemical marker combination that enables the diagnosis of violent asphyxiation in cases with a pre-existing CE (“AE in CE”). The cases comprised four diagnostic groups, namely “AE”, “CE”, “acute and chronic emphysema (AE + CE)”, and “no emphysema (NE)”. Samples from all pulmonary lobes were investigated by conventional histological methods as well as with the immunohistochemical markers Aquaporin 5 (AQP-5) and Surfactant protein A1 (SP-A). Particular attention was paid to alveolar septum ends (“dead-ends”) suspected as rupture spots, which were additionally analyzed by transmission electron microscopy. The findings in the four diagnostic groups were compared using multivariate analysis and 1-way ANOVA analysis. All morphological findings were found in all four groups. Based on histological and macroscopic findings, a multivariate analysis was able to predict the correct diagnosis “AE + CE” with a probability of 50%, and the diagnoses “AE” and “CE” with a probability of 86% each. Three types of “dead-ends” could be differentiated. One type (“fringed ends”) was observed significantly more frequently in AE. The immunohistochemical markers AQP-5 and SP-A did not show significant differences among the examined groups. Though a reliable identification of AE in CE could not be achieved using the examined parameters, our findings suggest that considering many different findings from the macroscopical, histomorphological, and molecular level by multivariate analysis is an approach that should be followed. |
| Databáze: | OpenAIRE |
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