6 thoughts on “two new cases for interest and discussion”

  1. Case 1:
    I’d call this myocarditis and try viral pcr. You’ve got good going inflammation (looks like lymphocytes predominantly) with cardiac myocyte destruction. Fits with the clinical history and macroscopic appearances too.

  2. First case: If these are lymphocytes I think a diagnosis of myocarditis is justified. Was fresh heart tissue retained for viral PCR? It does not explain the heart weight though. Was there a history of hypertension? Are there changes in the kidneys to suggest hypertension?

  3. Second case: Very interesting, thanks for sharing. Wouldn’t the single coronary artery with a heart weight of 800 g be enough to explain the cause of death due to ischaemia?

    1. possible to invoke ischaemia, but understand no IHD symptoms before
      also be aware that many GUCH (grown-up congenital heart disease) cases die at this time with unexpected dysrhythmic deaths and with no infarction etc

  4. Case 1: I’d go for myocarditis. My normal practice is to swab nasopharynx for viral PCR, but that is a limited panel of respiratory viruses and influenza. So would be tempted to keep fresh tissue for further analysis (difficult in hindsight!).

    Case 2: Great photos, thanks for sharing! If there are no further significant histological findings (e.g. inflammation/fibrosis) I’d probably give as 1a) Sudden death in operated congenital heart disease.
    Out of interest, how thoroughly would people sample the conduction system (assuming it’s relatively easy to find in a case like this?) representative sampling vs attempting to embed as much as possible and leveling ad infinatum?

    sks comment: worth a go at conduction system, but pathway can be difficult to find…do not over-expend time

    1. Even if you’ve not kept fresh tissue it’s worth trying virology on the paraffin block, and keep asking them to keep trying!! (Although I’ve yet to get a positive result frustratingly – I live in hope.)
      Esther

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