Premium
A Rare Case of Sudden Death Due to Hypotension during Cesarean Section in a Woman Suffering from Pheochromocytoma and Neurofibromatosis
Author(s) -
Cecchi Rossana,
Frati Paola,
Capri Oriana,
Cipolloni Luigi
Publication year - 2013
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/1556-4029.12279
Subject(s) - medicine , pheochromocytoma , neurofibromatosis , sudden death , autopsy , cardiomyopathy , pulmonary edema , pregnancy , anesthesia , surgery , pathology , cardiology , heart failure , lung , biology , genetics
Sudden death following acute hypotension due to an undiagnosed pheochromocytoma ( PHEO ) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37‐year‐old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra‐operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO , confirmed immunohistochemically with chromogranin‐A ( CgA ), CD 20 antibody ( L 26), anti‐ K eratocan antibody ( KER ‐1) and neuron‐specific enolase ( NSE ), and a PHEO ‐induced cardiomyopathy. The physiopathology of both stress‐induced cardiomyopathy and PHEO ‐induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues.