Sudden fatty liver death: a case report and overview

Is steatosis a risk factor for hepatic blunt force injury?

Hepatic steatosis is commonly seen in association with chronic ethanol use, obesity, diabetes mellitus, and infections or intoxications with certain viruses and/or medication/chemicals. Some forensic textbooks argue that livers with fatty infiltration are more susceptible to trauma. A study was designed to evaluate whether individuals with hepatic steatosis were at greater risk for liver trauma than those without steatosis. Individuals dying from blunt force injuries were evaluated for the presence or absence of hepatic trauma and hepatic steatosis. A grading system of steatosis was used resulting in scores ranging from 0 to 3: corresponding to none, mild, moderate, and severe steatosis. A total of 171 cases were reviewed, including 134 men and 37 women ranging from 17 to 61 years of age (average 30 years). Liver injury was present in 90 cases (53%) and absent in 81 cases (47%). A total of 78 cases (45.6%) showed no evidence of steatosis and 93 (54.4%) showed some element of steatosis with 58 (33.9%) showing mild, 19 (11.1%) moderate, and 16 (9.4%) severe steatosis. Statistical analysis failed to reveal an increased incidence of hepatic trauma within any of the steatotic groups as compared with the nonsteatotic group. Therefore, it can be concluded that hepatic steatosis does not lead to an increased risk of sustaining blunt force liver trauma.

Sudden death in the chronic alcoholic

A review of the causes of sudden death in 500 chronic alcoholics is presented. The deaths were fairly equally distributed between trauma, natural causes, acute intoxication and alcohol related disease. In a small but significant number, the cause is not initially clear although distinct patterns of death were evident.

Sudden unexpected natural death in young persons

In a series of 1920 medico-legal autopsies, 78 cases fulfilled the criteria of sudden unexpected natural death in the age group 2-30 years. In 39 (50%) of these cases a health hazardous condition was known. A large group included epileptics, alcoholics, obstetric/gynecologic conditions, and drug addicts. For prophylactic reasons the medical intervention should focus on earlier detection, if possible, of acute myocarditis, better instruction to epileptics as to thorough medication and information of parents. Physicians should be reminded about the danger of inflammatory processes in the upper respiratory tract, especially acute tracheobronchitis and acute epiglottitis.