title: Case report of death from falling: Did heart tumor cause syncope?
abstract: A healthy man in his 30s was working on the balustrade of stairs on the second floor. He suddenly fell downstairs without saying anything. On emergency hospitalization, chest echogram showed left hemothorax. Cardiac echogram showed a floating mass from the mitral valve in the left ventricle and severe mitral regurgitation. Surgery for hemothorax and pulmonary contusion was immediately undertaken. However, bleeding from pulmonary contusion could not be controlled and he underwent cardiopulmonary arrest. Autopsy showed a white, elastic, pendulous mass in the left atrium and a white mass in the lower lobe of the left lung. Tumor histology showed a reticular pattern, Schiller-Duval bodies, eosinophilic hyaline globules, and positive staining for α-fetoprotein. We diagnosed primary lung yolk sac tumor with metastatic intracardiac yolk sac tumor, a rare and highly malignant germ cell tumor. It usually arises in the ovaries and testes, and intracardiac yolk sac tumor is rare. Intracavitary tumors induce obstruction of inflow into and outflow from the ventricular cavity. The most common clinical presentation is dyspnea and syncope. In the present case, metastatic cardiac yolk sac tumor might have disturbed cardiac outflow and affected hemodynamics, probably causing syncope. Unfortunately, he was in a high place at that time and fell to receive pulmonary contusion that led to death. Autopsy may sometimes reveal latent diseases which might be related to the cause of death. We should perform autopsy thoroughly to diagnose not only the cause of death but also the factors leading to death.
authors.affiliation: Department of Legal Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan. yamamoto@legal.med.osaka-u.ac.jp
authors.forename: Takuma
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kosho
authors.initials: K
authors.lastname: Takasu
authors.forename: Yuko
authors.initials: Y
authors.lastname: Emoto
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shikata
authors.forename: Ryoji
authors.initials: R
authors.lastname: Matoba
mesh_terms: D000058:Accidental Falls; D000328:Adult; D003288:Contusions / Q000473:pathology; D018240:Endodermal Sinus Tumor / Q000473:pathology* / Q000556:secondary; D049429:Forensic Pathology; D006323:Heart Arrest / Q000209:etiology; D006325:Heart Atria / Q000473:pathology; D006338:Heart Neoplasms / Q000473:pathology* / Q000556:secondary; D006491:Hemothorax / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D013575:Syncope / Q000209:etiology*
references.citation: Adv Ther. 2007 May-Jun;24(3):529-32
references.pmid: 17660161
references.citation: Can J Cardiol. 2004 Dec;20(14):1443-8
references.pmid: 15614339
references.citation: Ann Thorac Surg. 2009 Jun;87(6):1925-6
references.pmid: 19463624
references.citation: Int J Legal Med. 2009 Mar;123(2):157-9
references.pmid: 19125270
references.citation: J Forensic Leg Med. 2008 Oct;15(7):454-6
references.pmid: 18761314
references.citation: Ann Thorac Surg. 2008 Feb;85(2):656-8
references.pmid: 18222293
references.citation: Am J Cardiol. 1997 Sep 1;80(5):671-82
references.pmid: 9295010
references.citation: Asian Cardiovasc Thorac Ann. 2008 Oct;16(5):410-1
references.pmid: 18812352
references.citation: Cancer. 1959 Nov-Dec;12:1092-105
references.pmid: 13837288
references.citation: Pediatrics. 2004 Apr;113(4):e374-6
references.pmid: 15060271
references.citation: Thorac Cardiovasc Surg. 1993 Aug;41(4):249-51
references.pmid: 7692620
references.citation: Int J Surg Pathol. 2006 Jul;14(3):247-51
references.pmid: 16959714
references.citation: J Postgrad Med. 2002 Jan-Mar;48(1):29-31
references.pmid: 12082324
references.citation: Clin Cardiol. 1999 Jun;22(6):429-33
references.pmid: 10376186