Lauren R. Boglioli

Religious objection to autopsy. An ethical dilemma for medical examiners

In recent years, religious objection to autopsy has become an ethical dilemma for medical examiners. We present two cases that illustrate these dilemmas, and we also review the history and legal considerations of religious objection to autopsy.

Sudden Asphyxial Death Due to a Prolapsed Esophageal Fibrolipoma

Fibrolipomas of the esophagus are extremely uncommon benign tumors. Accurate diagnosis and resection are essential, due to their tendency to become impacted and obstruct the airway. The case is presented of a 56-year-old man who died suddenly of asphyxia because of upper airway obstruction by a prolapsed fibrolipoma of the esophagus.

A case of autoerotic asphyxia associated with multiplex paraphilia.

During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.

Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma.

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.

Sudden Death Due to Sarcoid Heart Disease

A case of sudden death due to massive myocardial sarcoidosis is presented. Cardiac sarcoidosis is discussed. Since the deceased was a New York City police officer with death benefit entitlements under the Heart Bill, the implications of the medicolegal autopsy are emphasized.

A bizarre case of vehicular suicide

The upper torso of a man was discovered under a highway sign next to tire tread marks leading from the highway and continuing beyond the sign. The victims lower torso and automobile were also found along the same path 31 m (101 ft) and 41 m (133 ft) beyond the sign, respectively. The decedent was initially thought to be a disposed, homicide victim who had been dismembered by his assailant(s). Accident reconstruction revealed that the victim was the driver of the automobile and was transected by the highway sign stanchion as he protruded through the passenger side window of his moving vehicle. Based on the scene findings, autopsy, and psychological autopsy, the manner of death was classified as suicidal. The criteria used by medical examiners for vehicular suicide are also discussed.

Death During Percutaneous Insertion of an Intraaortic Balloon Pump

Intraaortic balloon counterpulsation is currently the most widely used mechanical technique for temporary support of the circulation. We report a rare fatal case of perforation of the right common iliac artery during percutaneous insertion of an IABP.

Sudden death due to ruptured pancreaticoduodenal artery aneurysm.

Superior pancreaticoduodenal artery aneurysms are rare; their rupture often leads to sudden death. We report a case of a 59-year-old hypertensive man who died of a massive retroperitoneal hemorrhage following rupture of an aneurysm of the superior pancreaticoduodenal artery. We also discuss this unusual vascular lesion and review the pertinent literature.

Death by Fraternity Hazing

Fraternity hazing can cause a variety of injuries and deaths. We recently had the opportunity to investigate a heat-related death that occurred during a college fraternity event. The original death investigation did not consider the circumstances of death, environmental conditions, or the subtle autopsy findings related to heat stroke. This case is intended to alert health care professionals that deaths on college campuses may be related to fraternity hazing and may require in-depth investigations. An analysis of the death and a discussion of heatrelated injuries are presented.

Homicidal traumatic asphyxia associated with pebble impaction of the upper airway

The news media tend to sensationalize murders involving multiple methods because of their inherent brutality. Similarly, when addressing a jury, prosecutors often emphasize the most grisly part of a murder to ensure a speedy conviction. This paper reports a case of a teenage boy who was murdered by the use of multiple methods of asphyxia. The methods of asphyxial death and the reconstruction of the sequence of events by the medical experts during the murder trial played an important role in the conviction and ultimate sentencing of the perpetrators.