title: [An autopsy case of pulmonary thromboembolism: a delayed complication of a victim by traffic accident].
abstract: A 35-year-old male had fallen down from his motor bike caused a fracture of the medial condyle of the right tibia and the acromion of the left scapula. He had received screw fixed operation for his right tibia and had been in the hospital for one month. He died suddenly in the hospital and was autopsied to find out the cause of death. On external examination, it was found that affected leg was bruised and swollened. Partially organized thrombosis in the posterior tibial vein was revealed and bilateral pulmonary arteries were packed with reddish massive thromboemboli. The causes of the posterior tibial vein thrombosis were intimal damage and decreased venous flow, attributable to bed rest for long days and external fixation of the lower extremity. We presumed that direct cause of death was a large thromboemboi which were migrated from posterior tibial vein and lodged at the bifurcation of the pulmonary artery causing obstruction of pulmonary blood flow. Finally we opened the direct cause of death was pulmonary thromboembolism due to leg injury. Clinical instability may hinder the diagnostic elevation and delay therapeutic intervention, it is the most often happened in sudden death cases within the hospital. The importance of early diagnosis and early prevention is underscoped, because the symptoms of pulmonary thromboembolism are not always produced. To prevent fatal pulmonary thromboembolism in trauma, prophylactic use of low-dose heparin therapy and/or the use of oral anticoaglant (warfarin) have been effective and recommended in USA and Western Europe. The routine use of these therapy has not yet been spread in Japan, because the incidence is still apparently lower than in USA and Western Europe as well as the risk of hemorrhage. If the victims of road traffic accident receive the prophylactic use of low-dose heparin and/or oral anticoaglant (warfarin), it might be an effective way to reduce mortality.
authors.affiliation: Department of Legal Medicine, Osaka University Medical School, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yamazaki
authors.forename: H
authors.initials: H
authors.lastname: Bai
authors.forename: H
authors.initials: H
authors.lastname: Kuroki
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
authors.forename: C
authors.initials: C
authors.lastname: Wakasugi
mesh_terms: D000063:Accidents, Traffic; D000174:Acromion / Q000293:injuries*; D000328:Adult; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology* / Q000473:pathology*; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*