Bilateral spontaneous pneumothorax secondary to aspiration pneumonia induced by a wristwatch lodged at the pharyngoesophageal junction.
Bilateral spontaneous pneumothorax secondary to disease is rare and seldom encountered in forensic autopsies; however, traumatic bilateral pneumothorax occurs often. Herein, we present a forensic case involving a 50-year-old woman who died 4 days after ingesting a wristwatch. Postmortem computed tomography and autopsy findings demonstrated that the wristwatch was lodged at the pharyngoesophageal junction, that she had a bilateral pneumothorax unaccompanied by any thoracic wound, and that macular hemorrhagic lesions on the lung surfaces were responsible for the pneumothorax. A histological examination of the macular lesions revealed that they were aspiration pneumonia foci with many birefringent foreign materials. Furthermore, a necrotic process secondary to aspiration pneumonia with a one way check-valve hyperinflation caused by foreign materials in the bronchioles was the most probable pathogenesis of her pneumothorax. To our knowledge, this is the first reported case of a bilateral secondary spontaneous pneumothorax caused by a large foreign body at the pharyngoesophageal junction leading to death.
Department of Forensic Medicine, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Chihiro
C
Kawai
Masashi
M
Miyao
Hirokazu
H
Kotani
Keiji
K
Tamaki
D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D049429:Forensic Pathology; D006801:Humans; D008875:Middle Aged; D010614:Pharynx / Q000000981:diagnostic imaging / Q000473:pathology; D011015:Pneumonia, Aspiration / Q000150:complications* / Q000209:etiology*; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011859:Radiography; D012565:Schizophrenic Psychology