Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series

An infantile case of asphyxia with coincidental myocarditis

A six-month-old infant was found dead in a small dustbin in an upside-down position. The police investigation showed that there was no criminal environment including negligence. Analysis at the scene suggested death caused by asphyxia (wedging death). Microscopically, however, diffuse lymphocyte infiltration was observed in the interstitial spaces of the myocardium. Common symptoms of infantile myocarditis are generally non-specific, and the predominant neurological problem is a decrease in activity. The records of rectal temperature suggested that the decedent was dead without a high fever. In the present case, there was no obvious relationship between myocarditis and movement of the infant. We conclude that myocarditis was coincidental to the cause of death by asphyxia.

Cardiac findings in fetal and pediatric autopsies: a five-year retrospective review

This review aims to determine the spectrum of cardiac findings in our fetal and pediatric postmortem population and provide an analysis of associated extracardiac malformations and genetic abnormalities. Pediatric autopsy reports from 2003 to 2007 inclusive were reviewed and cases with cardiac pathology selected for analysis. Over the 5-year period, 119 cases (10.8%) with abnormal cardiac findings were identified from a total of 1102 postmortem examinations. Of these cardiac cases, 42% were after termination of pregnancy for fetal anomaly, 29% after fetal demise, 14% after neonatal unit death, 3% after hospital inpatient death, and 11% after sudden unexpected death. Structural abnormality cases numbered 107 (90%), with ventricular septal defect as the most common individual defect. Nonstructural abnormality cases, such as myocarditis, numbered 12 (10%). Extracardiac malformations were identified in 78%. Chromosome or gene aberrations were detected in 37%. This review highlights the potential benefit of introducing routine fetal anomaly scanning, the need for cardiac pathology training for pediatric pathologists, and the importance of examination of the heart and associated vessels in all cases to provide parents with as much information as possible and aid identification of the etiology and associations of cardiac pathology.