Development of the respiratory diaphragm in childhood: diaphragmatic contraction band necrosis in sudden death.
The authors studied the respiratory diaphragm in 50 normally grown infants and children aged 1 to 16 years at the time of sudden death. By comparing the weights of both costal diaphragm and heart with age and height, the authors found that the diaphragm grows proportionately to the body as a whole and to the heart in particular. Diaphragmatic contraction band necrosis was found in 15 cases (30%). The incidence was similar in subjects dying of asphyxia (five of 21) to that in those dying of trauma (five of 20). It was present in two of 15 of those that died at once, and 13 of 35 of those who survived for varying periods with or without cardiopulmonary resuscitation. Myocardial contraction band necrosis was more common than diaphragmatic contraction band necrosis, being present in five of 11 of those who died at once, and 16 of 26 of those that survived for a period. Among individual subjects, the authors found no correlation of the presence of the diaphragmatic lesion with either cause or mode of death. Based on a comparison with the morphologically similar myocardial lesion, the etiopathogenesis of diaphragmatic contraction band necrosis may concern a local catecholamine effect.
Silver
M M
MM
Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada.
Denic
N
N
Smith
C R
CR
D000293:Adolescent; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D003645:Death, Sudden; D003964:Diaphragm / Q000473:pathology* / Q000502:physiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009119:Muscle Contraction; D009206:Myocardium / Q000473:pathology; D009336:Necrosis