3 thoughts on “is this disarray ?”

  1. I’m not sure that the disarray here is disorganised enough for a diagnosis of HCM, I’d favour hypertensive disease. In some of the pics the fibrosis looks more homogenous, is it worth a Congo Red to exclude amyloid?

    I’d also like to correlate with any family history, if it’s suspicious then I’d take things further (i.e. suggest screening in first degree relatives).

  2. If it’s away from the septum (and you promised it is) I would agree the disarray is genuine.
    Was he on CPAP? If yes, was the mask still on his face when he was found?

  3. I think this is a difficult case
    there is some disarray, but not classic
    some of the sample appear to come from sites where a degree of ‘fibre irregularity’ is known, and scarring may also cause non-standard arrangement

    a reasonable way forward is to check the FH and prior medical history….if few features for HCM then may just be reactive effects
    but always worth keeping spleen and communicating some uncertainty to Fiscal/ Coroner and indeed family in case they wish review medically

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