Korean J Leg Med.  2018 Nov;42(4):159-163. 10.7580/kjlm.2018.42.4.159.

An Experience of Judicial Autopsy for a Death by Muscular Dystrophy: An Autopsy Case

• Kim YS
• Park JH

• KMID: 2427563
• DOI: http://doi.org/10.7580/kjlm.2018.42.4.159

Abstract

Progressive muscular dystrophy (PMD) is a primary muscle disease characterized by progressive muscle weakness and wasting, which is inherited by an X-linked recessive pattern and occurs mainly in males. There are several types of muscular dystrophies classified according to the distribution of predominant muscle weakness including Duchenne and Becker, Emery-Dreifuss, facioscapulohumeral, oculopharyngeal, and limb-girdle type. Clinical manifestations of PMD are clumsy, unsteady gait, pneumonia, heart failure, pulmonary edema, hydropericardium, hydrothorax, aspiration, syncopal attacks, and sudden cardiac death. The deceased was a 34-year-old man, and the onset of the first clinical symptom, gait disturbance, was in his late teens. His elder brother had the same disease and experienced brain death after a head trauma and died after mechanical ventilation was discontinued. After an autopsy, we found contracture of the joints, pseudohypertrophy of the calf, wasting and fat replacement of the thigh muscle, pericardial effusion (80 mL), fibrosis and fat replacement of the cardiac ventricular wall, pulmonary edema, and froth in the bronchus. The cause of death was heart failure and dyspnea due to muscular dystrophy. There was no sign or suspicion of foul play in his death.

Keyword

Muscular dystrophies; Gait disturbance; Autopsy

MeSH Terms

Adolescent
Adult
Autopsy*
Brain Death
Bronchi
Cause of Death
Contracture
Craniocerebral Trauma
Death, Sudden, Cardiac
Dyspnea
Fibrosis
Gait
Gait Disorders, Neurologic
Heart Failure
Humans
Hydrothorax
Joints
Male
Muscle Weakness
Muscular Dystrophies*
Pericardial Effusion
Pneumonia
Pulmonary Edema
Respiration, Artificial
Siblings
Thigh

Figure

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  Fig. 1 A photograph showing pseudohypertrophy of the calf area.

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  Fig. 2 Dissection of the thigh shows yellow discoloration of the muscle.

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  Fig. 3 Histology of the muscle shows replacement of muscle fiber by fat tissue (H&E stain, ×50).

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  Fig. 4 On the cut section of the heart, fibrotic foci are noted on the ventricle wall.

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  Fig. 5 Microscopic examination of the heart wall reveals fibrosis of the muscle and replacement by fat tissue (H&E stain, ×50).

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