By Editorial Staff
Published May 31, 1983
MAUREEN LYNNE TYKE
REPORT ON AUTOPSY (Emphasis added)
- DECEASED: TYKE, MAUREEN LYNNE
- Lab. Acc. No.A: 83-128-LMA
- AGE: 21 RACE: W SEX: F
- HOSPITAL NO: 328721 6
- Legal: A-83-128-LMA **
- PHYSICIAN: Dr. Sandberg Q830515318 Date of Death: 5/31/83
- Date of Autopsy: 5/31/83 Time of Death: 4:15 A.M. Time of Autopsy: ———-
LUNGS: Pulmonary atelectasis, total.
Hydrothorax, bilateral, 1800 ml. bilateral.
HEART: Myocarditis, diffuse, florid, probably viral etiology. Dilatation, all chambers.
LIVER: Passive congestion, marked.
KIDNEYS: Congestion, acute.
GENITALIA: Surgical absence, recent, uterus, tubes, ovaries.
CENTRAL NERVOUS SYS: Cerebral edema, mild.
GENERAL: Cyanosis, extreme. Ascites, moderate.
Post-abortion status, four days.
TOXICOLOGY: Negative studies.
CAUSE OF DEATH: MYOCARDITIS, DIFFUSE, PROBABLY VIRAL ETIOLOGY, WITH HEART FAILURE AND SHOCK, OCCURRING IN POST-ABORTION STATUS.
Pathologist: L. E. McHenry, MD – Brevard County, Florida – Medical Examiner
CLINICAL SUMMARY: This is a legal investigation. This 21 year old Caucasian female was admitted to the hospital on 5/29/83, apparently in extreme septic shock, following an outpatient abortion, at the Aware Woman Clinic, on 5/27/83. According to the records at the Clinic and by history, the abortion was uneventful, other than the fact that she was noted to have a complete double uterus and double cervix. Approximateiy 24 hours after the abortion, she developed nausea, vomiting, chills and malaise, and at the time of admission, she had fever, chills, extreme weakness and was cyanotic and hypotensive. In spite of vigorous therapeutic and resuscitative measures, the course continued downhill and in an attempt to remove focus of infection, a hysterectomy and bilateral salpingo-oophorectomy were carried out. This did not alter the course and death occurred in the early A.M. of 5/31/83. See charts for specific details of therapy and the clinical course.
EXTERNAL EXAMINATION: The body is that of a young adult Caucasian female, measuring 5’10“in total body length, weighing 193 pounds. A Swan-Gantz catheter is in normal location, entering the body in the right upper anterior chest. A catheter into the vascular system is also present in the right neck. In the midline of the lower abdomen, there is a recently sutured incision and on either side of this there are drainage tubes in place and connected to a hemovac 400 ml. evacuator. This contains a small amount of amber colored clear fluid. There is extreme cyanosis of the nail beds and mucous membranes and posteriorly dependent lividity. No indications of trauma or injuries are noted. The hair is dark brown to black, the irides are dark brown. The teeth are natural, with apparently good hygiene. No other unusual discolorations are noted. The breasts are full, possibly somewhat tense and show no unusual features.
PRIMARY BODY INCISION: The usual body incision shows essentially normal anatomic relationships of the internal viscera. Copious amounts of blood tinged, but basically watery, pleural fluid is present bilaterally, at least 1800 ml. on each side of the chest. A moderate amount of ascitic fluid, clear and yellowish, is also present.
CARDIOVASCULAR SYSTEM: The pericardium is opened to reveal an excessive amount, but not a dysfunctional amount of pericardial fluid. The heart weighs 450 grams, and shows a flabby diffuse consistency and all cardiac chambers seem dilated. Dissection of the heart shows no obvious abnormal features of the endocardium and the cardiac valves show no obvious abnormal features. No congenital defects are demonstrated. The coronary arteries are clear and without disease throughout. Dissection of the myocardium shows a conspicuously pale tan color, lighter than normal, but with no evidence of necrosis or focal areas of change. The aorta and major vessels show no unusual features. No thrombi or emboli are demonstrated.
PULMONARY SYSTEM: Both lungs show the solid reddish consistency of total atelectasis, with no evidence of crepitation whatsoever. The left lung weighs 700 grams, the right lung 550 grams. This is presumably related to the massive bilateral hydrothorax. Exudate is not recognized in the pulmonary tissue. The cut pulmonary tissue is a homogeneous dark red throughout, again without evidence of aeration. The tracheobronchial system appears clear, although the mucosa is hyperemic.
GASTROINTESTINAL TRACT: The G.I. tract shows no unusual features throughout its length. LIVER: The liver weighs 1150 grams and shows a conspicuous pattern of chronic and acute passive congestion. The gallbladder and the bile ducts show no unusual features.
SPLEEN: The spleen is enlarged, weighing 450 grams and shows a splenic pulp with marked decreased consistency.
ADRENALS: The adrenal glands show no unusual gross features.
GENITOURINARY SYSTEM: Each kidney weighs 200 grams and shows evidence of marked congestion. The renal calyces, pelves, and ureters are not remarkable. The urinary bladder has hemorrhagic discoloration of the mucosa, and in the area of the trigone, the mucosa of the urinary bladder is discolored a greenish-grey color. External genitalia show no abnormal features. The recently sutured repair of the removed uterus, tubes and ovaries is apparent and no unusual features are noted. There is no discoloration or exudate apparent in the tissues surrounding this area or the pelvis.
SKELETAL SYSTEM: No abnormal features noted.
LYMPHATIC SYSTEM: Some of the pelvic lymph nodes are mildly hyperplastic, with no other changes noted in this system.
CENTRAL NERVOUS SYSTEM: The scalp and calvarium are not remarkable. Removal of the skull cap shows equivocal flattening of the cerebral cortex, suggestive of some cerebral edema. The weight would tend to confirm this, being 1375 grams. There is no evidence of hemorrhage or exudates and tedious dissection of the entire central nervous system shows no evidence of hemorrhages or petechiae or exudates or other disease process. The same can be said for the dissection of the brain stem, cerebellum and upper cervical cord. The dural layers show no unusual features. The pituitary shows no abnormal features.
BACTERIOLOGICAL STUDIES: Cardiac blood is obtained with difficulty, because of the clotted status of all blood. That blood obtained is placed in blood culture containers. Notation should be made that an antemortem blood cluture blood study was initiated also. A very small amount of cloudy urine is present in the bladder and this is submitted for bacteriological studies also.
TOXICOLOGIC STUDIES: Deemed unnecessary.
The reader is referred also to surgical pathology reports, S-83-4218 and S-83-4385, copies of which are attached to this autopsy report. Sections of the autopsy material confirm the secondary atelectasis in most of the pulmonary tissue. In the kidneys early, but definite tubular necrosis, involving the convoluted tubule system is confirmed. Some of the glomeruli apparently are involved in this ischemic necrosis, but for the most part, the glomeruli seem intact, as do the other structures of the kidney. The ischemic necrosis of the convoluted tubules presents as total coagulated necrosis of the convoluted tubular cells, maintaining their normal configuration. The heart is the site of the major pathologic process. There is a diffuse infiltration of myocardium, in all areas of the heart, by a predominantly lymphocytic infiltrate, but in which also are found-some histiocytes and eosinophiles. The myocardial fibrils suggest some areas of degenerative vacuolization and there seems to be some fragmentation of the myocardial fibers in some areas. This has the appearance of florid viral or lymphocytic myocarditis. Sections of other tissue are confirmatory of the gross diagnosis or show no unusual features.
The death of this young Caucasian female is attributed to the florid myocarditis, probably of viral etiology, and the effects seen in most organs has to do with heart failure, secondary to myocarditis or the shock status in which this patient was in for most of terminal hospitalization. * In my opinion, the myocariditis is a disease which probably preceded and apparently was present at the time of the abortion. The intensity of this myocarditis should indicate that the young woman was very ill and there should have been some signs or symptoms of serious illness at the time that she was being prepared for the abortion. * The complications in the hospital, chief of which were the shock and the cardiac conduction problems and heart failure, were undoubtedly attributable to the diffuse myocarditis. This case will be submitted to consultants with supplemental report as indicated.
Bacteriological studies performed on blood, abdominal fluid and bladder urine were negative; studies from the cervix were positive for Escherichia coli, Diphtheroids, Staph haemolyticus (coag. neg.)
Blood alcohol=negative; No drugs detected by Toxi-lab method; immunoassays for amphetamines, barbiturates, cocaine, opiates, methaqualone, PCP and benzcydiazepines were all negative.
FINAL PATHOLOGIC DIAGNOSES
See cover sheet.
FINAL CAUSE OF DEATH
See cover sheet.
Signed by: L. E. McHenry, MD
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