title: Fatal laryngeal angioedema: a case report and a workup of angioedema in a forensic setting.
abstract: Angioedema is an episodic swelling of the deep dermis, subcutis, and/or submucosal tissue due to an increase in local vascular permeability. Swelling may involve skin, respiratory, and gastrointestinal tracts. The most commonly involved areas are the periorbital region and the lips. Here we report a case of a fatal laryngeal obstruction due to angioedema likely caused by an angiotensin-converting-enzyme inhibitor. The decedent, a 58-year-old man, was witnessed developing sudden facial swelling and acute respiratory difficulties quickly followed by unresponsiveness. His past medical history suggested that this was his second episode of angioedema without urticaria. Postmortem examination revealed a complete laryngeal obstruction in the absence of infection, neoplasm, or autoimmune disease. Postmortem computed tomography of the head and neck showed a complete obstruction of the upper airway. Based on the current understanding of the pathophysiology of different types of angioedema, we will suggest a workup of angioedema without urticaria in the forensic setting and offer readers resources they can use in their practice.
authors.affiliation: Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, ON, Canada. Adriana.krizova@mail.utoronto.ca.|Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Adriana.krizova@mail.utoronto.ca.|Department of Pathology, St. Michael's Hospital, Toronto, ON, Canada. Adriana.krizova@mail.utoronto.ca.
authors.forename: Adriana
authors.initials: A
authors.lastname: Krizova
authors.affiliation: Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, ON, Canada.
authors.forename: Taylor
authors.initials: T
authors.lastname: Gardner
authors.affiliation: Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, ON, Canada.|Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
authors.forename: D'Arcy L
authors.initials: DL
authors.lastname: Little
authors.affiliation: Forensic Services and Coroner's Complex, Toronto, ON, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Arcieri-Piersanti
authors.affiliation: Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pollanen
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000473:pathology; D000799:Angioedema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D017809:Fatal Outcome; D006801:Humans; D007818:Laryngeal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACEI induced angioedema; Angioedema; Angioedema workup in forensic pathology; Drug induced angioedema; Postmortem CT of angioedema