Cardiac concussion: definition, differential diagnosis, and cases presentation and the legal ramification of a misdiagnosis.
A cardiac concussion is caused by a sudden, nonpenetrating, localized impact to the chest that is theorized to result in almost simultaneous sudden death from a disruption to the conductive system. The detailed external/internal forensic examination of the body reveals no evidence of structural, pathologic, or histologic signs of trauma to the heart. A cardiac concussion is a rare and often overlooked cause of sudden death. This type of sudden death is typically seen among younger individuals participating in sports involving projectiles and, to a lesser degree, where collisions occur. Cardiac concussions are clinically, pathologically, and chemically different from a cardiac contusion. The objective of this paper will be to define cardiac concussion, differentiate between cardiac concussion and cardiac contusion, and describe the clinical and pathologic features of a 32-year-old white male who died of a cardiac concussion following a collision with a catcher during a softball game. The civil ramification of incorrectly diagnosing the manner of death in cases of death involving a cardiac concussion will also be addressed.
Allegheny County Coroner's Office, Pittsburgh, Pennsylvania, USA. skoehler@county.allegheny.pa.us
Steven A
SA
Koehler
Abdulrezak
A
Shakir
Shaun
S
Ladham
Leon
L
Rozin
Bennet
B
Omalu
Joe
J
Dominick
Cyril H
CH
Wecht
D000328:Adult; D001265:Athletic Injuries / Q000150:complications; D003288:Contusions / Q000175:diagnosis; D016757:Death, Sudden, Cardiac / Q000209:etiology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005554:Forensic Medicine; D006335:Heart Injuries / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*