All that wheezes is not asthma--Alternative findings at autopsy.
A number of questions must be asked before asthma can be accepted as a valid diagnosis: were the episodes of shortness of breath investigated? Are there changes at autopsy in keeping with asthma? Did asthma either contribute to the terminal episode, cause death, or was it coincidental? Finally, is it possible that other conditions may have accounted for the clinical manifestations? A review of files at FSSA over a 10-year period from 1999 to 2008 identified six cases where shortness of breath and/or wheezing had been incorrectly attributed to asthma. Five were due to pulmonary thromboembolism and one to multiple injuries. In the latter case, an irreducible, left-sided diaphragmatic hernia was present. There was no morphological evidence of asthma in any case. Autopsy examination may, therefore, be crucial in revealing other conditions that may have caused or contributed to episodic breathlessness that may have been incorrectly attributed to asthma.
Byard
Roger W
RW
Discipline of Pathology, The University of Adelaide, Frome Rd, Adelaide, SA 5005, Australia. byard.roger@saugov.sa.gov.au
D000063:Accidents, Traffic; D000328:Adult; D001249:Asthma / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004417:Dyspnea / Q000209:etiology*; D049429:Forensic Pathology; D006548:Hernia, Diaphragmatic / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000473:pathology; D009765:Obesity / Q000150:complications; D001261:Pulmonary Atelectasis / Q000473:pathology*; D011655:Pulmonary Embolism / Q000473:pathology*; D012135:Respiratory Sounds / Q000209:etiology*; D012189:Retrospective Studies