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.

Acute versus chronic pulmonary emphysema Aquaporin 5 Surfactant protein A1 Transmission electron microscopy Violent asphyxiation

Journal

International journal of legal medicine
ISSN: 1437-1596
Titre abrégé: Int J Legal Med
Pays: Germany
ID NLM: 9101456

Informations de publication

Date de publication:
Jan 2022
Historique:
received: 28 12 2020
accepted: 30 04 2021
pubmed: 29 6 2021
medline: 7 4 2022
entrez: 28 6 2021
Statut: ppublish

Résumé

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.

Identifiants

pubmed: 34181078
doi: 10.1007/s00414-021-02619-7
pii: 10.1007/s00414-021-02619-7
pmc: PMC8813827
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

133-147

Informations de copyright

© 2021. The Author(s).

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Auteurs

Giuseppe Gava (G)

Institute of Legal Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Simon B Eickhoff (SB)

Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.

Timm J Filler (TJ)

Institute for Anatomy I, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Felix Mayer (F)

Institute of Legal Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Nina S Mahlke (NS)

Institute of Legal Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. ninasophia.mahlke@med.uni-duesseldorf.de.

Stefanie Ritz-Timme (S)

Institute of Legal Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

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