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Farid M, Zohny E, Ismail A, Ateya M, Abdel-Razek A, Hamed N, Elmarakby A, Hassanin A, Ismail A, Mansour O, Roshdy H, Ahmed Y, Ismail M, Amin HAA. Bone marrow embolism: should it result from traumatic bone lesions? A histopathological human autopsy study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00609-2. [PMID: 37133760 DOI: 10.1007/s12024-023-00609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/04/2023]
Abstract
Bone marrow embolism (BME) is likely a consequence of fractures in which pulmonary vessels are the most affected. However, some cases of BME were reported in the absence of trauma. Thus, a traumatic injury might not be necessary for developing BME. This study discusses BME cases in patients without signs of fractures or blunt trauma. The discussion addresses various possible mechanisms for the appearance of BME. Options include cancer in which bone marrow metastasis is a suggestive cause. Another proposal is the chemical theory where bone marrow fats are released via lipoprotein lipase in a pro-inflammatory state, resulting in vascular/pulmonary obstruction. Other cases discussed in this study are hypovolemic shock and drug-abuse related BME. All autopsy cases with BME were included regardless of the cause of death for a period of 2 years. Autopsies involved complete dissection with the macroscopic evaluation of the affected organs, including the heart, lungs, and brain. Tissues were also prepared for microscopic examination. Of the 11 cases, eight showed non-traumatic BME (72%). These findings conflict with theories in the literature that BME most commonly occurs after fractures or trauma. One of the eight cases exhibited mucinous carcinoma; one is presented with hepatocellular carcinoma; and two cases showed severe congestion. Lastly, one case was found to be associated with each of the following conditions: liposuction, drug abuse, pulmonary hypertension, and heart failure. Each case suggests a different pathophysiology for developing BME, yet the exact mechanisms are not fully understood. Further study of non-traumatic associated BME is recommended.
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Affiliation(s)
- Maha Farid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Esraa Zohny
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariem Ateya
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Nermien Hamed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Arwa Hassanin
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Omar Mansour
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hossam Roshdy
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Yehia Ahmed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariam Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hebat Allah A Amin
- Department of Pathology, Faculty of Medicine, Helwan University, Cairo, Egypt
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Ondruschka B, Baier C, Bernhard M, Buschmann C, Dreßler J, Schlote J, Zwirner J, Hammer N. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol 2018; 15:48-55. [PMID: 30443888 DOI: 10.1007/s12024-018-0044-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/27/2022]
Abstract
Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group 'ACCD', 'mCC' and 'no CPR'. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.
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Affiliation(s)
- Benjamin Ondruschka
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany.
| | - Christina Baier
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Michael Bernhard
- University Hospital, Emergency Department, Heinrich Heine University, Duesseldorf, Germany
| | - Claas Buschmann
- Institute of Legal Medicine, Charité-Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Dreßler
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Julia Schlote
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
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