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November 15, 2001

Beth Israel Deaconess Medical Center
[directions]

Scientific Session

4:30 P.M.

"CURRENT ISSUES RELATED TO THE AUTOPSY"

Michael J. O'Brien, M.D., Ph.D.
Professor of Pathology,
Boston University School of Medicine
Boston, Massachusetts

Sherman Auditorium
(Sherman Building, Room 179)
Cocktails 5:30 P.M. Shapiro Clinical Center Atrium
Dinner 6:15 P.M. Information about making dinner reservations Shapiro Clinical Center Atrium
Business Meeting 7:15 P.M. Sherman Auditorium
(Sherman Building, Room 179)
Evening Slide Seminar 7:30 P.M.

"PRESENTATION OF AUTOPSY CASES"

Presenters:

David R. Genest, M.D.
Brigham and Women's Hospital

Eugene J. Mark, M.D.
Massachusetts General Hospital

Bruce A. Woda, M.D.
University of Massachusetts Medical Center

Sherman Auditorium
(Sherman Building, Room 179)























Top Case 1 Case 2   Case 3 

Case #1

Presented by David R. Genest, M.D.
Associate Professor of Pathology
Harvard Medical School & Brigham and Women's Hospital

  1. A 38-week-old infant with early neonatal death from pulmonary hypoplasia with massively enlarged symmetrical kidneys
  2. A 40-week-old male infant with early neonatal death from pulmonary hypoplasia with markedly distended abdomen.













































Top Case 1 Case 2 Case 3 

Case #2

Presented by Eugene J. Mark, M.D.
Director of Autopsy Service, Massachusetts General Hospital
Associate Professor of Pathology
Harvard Medical School & Massachusetts General Hospital

A 48-year-old obese female came to the Emergency Room with anxiety and slight dyspnea and pain in the upper chest and shoulder area. An orthopedic consult made a diagnosis of musculoskeletal strain. The patient was sent home with a prescription for ibuprofen. Ten days later at home she experienced severe shortness of breath. She called her primary care physician, who was out of town, and she was instructed to go to the Emergency Room. She was waiting in the Emergency Room for four hours when cardiopulmonary arrest occurred. Resuscitation was unsuccessful. At autopsy large clots were present in three lobar pulmonary arteries. No infarction was present. The certificate of death listed "pulmonary emboli, minutes" as the cause of death based on the gross findings.

Questions to be addressed during the talk:

  1. How does one assess the significance of the fresh blood clot in pulmonary arteries grossly?
  2. How does one date an old embolus?
  3. How does one date an acute embolus?
  4. How does one date a pulmonary infarct?
  5. Which embolus caused which symptom?
  6. How large must an embolus be to cause sudden death?
  7. What are the repercussions of the answers for these questions to the attending physicians and to the hospital?













































Top Case 1 Case 2 Case 3 

Case #3

Presented by Bruce A. Woda, M.D.
Professor and Vice Chairman
Director, Division of Anatomic Pathology and Hematopathology
Department of Pathology
University of Massachusetts Memorial Medical Center

The patient was a 52-year-old female with a history of weight loss and anemia. She collapsed suddenly and was asystolic on arrival to the Emergency Department where she could not be resuscitated. Her past medical history is significant for epigastric pain and bouts of vomiting. A urinalysis revealed proteinuria and an abdominal CT scan performed the week before death revealed hepatomegaly.