Sudden cardiac death (SCD) is a known risk of hypertrophic cardiomyopathy (HCM), especially in asymptomatic and younger (<35 years old) populations. There are several mutations that cause HCM, most notably within the MYBPC3 and MYH7 genes. ALPK3 (alpha protein kinase 3) has been identified as a gene of interest in HCM, specifically associated with late-onset adult HCM or pediatric cases which typically present with musculoskeletal and facial deformities. In this report, we present a case of SCD due to HCM in a young, reportedly asymptomatic patient without dysmorphia that had a specific mutation of the ALPK3 gene and a striking gross pathological appearance previously undiscussed in literature.

Estimation of hydration status in paediatric deaths provides valuable insight into contributors of mortality including dehydration and paediatric neglect. Diaper weights have been used in postmortem settings to indirectly assess fluid status. However, clinical literature suggests storage conditions may affect the accuracy of these estimates. This study examines the weight change in commercially available diapers stored within different postmortem conditions. Five replicates of dry, wet, and saturated diapers were stored at 4 °C and -20 °C in either a body bag or left exposed to environment. Weights were measured daily over 5 consecutive days. Statistically significant changes in diaper weight were observed across all groups. Overall dry diapers increased in weight, whereas wet/saturated decreased in weight (Pearson and paired t test, P < 0.05) for up to 9 g (~30% in dry and ~9% in wet/saturated diapers). However, when body bags were used, the average changes were <1 g (maximum: 3 g) across all diapers and temperatures. The findings of this study suggest that while diaper weight may be influenced by different postmortem environments, diapers stored in sealed body bags demonstrate more stability, thus may assist in providing a more accurate assessment of hydration status in paediatric deaths.

Postoperative meningitis, although rare, remains a devastating complication following neurosurgical procedures. This case report describes a 55-year-old male who succumbed to bacterial meningitis after lumbar laminectomy for intervertebral disc prolapse. Autopsy findings revealed extensive purulent exudate in the subarachnoid space, and microbiological analysis confirmed the presence of Acinetobacter baumannii complex and Pseudomonas aeruginosa. This case highlights the rapid and aggressive nature of nosocomial meningitis, the challenges in early diagnosis, and the critical importance of vigilance for atypical and multidrug-resistant pathogens in the post-operative period.

Maternal mortality, a global concern, is mitigated by the accurate determination of the cause of death. Maternal death autopsies in our institution fall under pathology, except those under forensic medicine due to medicolegal implications. This study compares provisional (PCOD) and final (FCOD) causes of death in maternal autopsies, driven by queries from clinicians during Maternal Death Review meetings regarding discrepancies between the two. This retrospective study analyzed 92 maternal death autopsies with discrepancies between PCOD and FCOD, over a 6-year period at a tertiary care hospital. Discrepancies were classified into major and minor for organ-specific diagnoses. The commonest encountered pathologies were assessed for true positives, false positives, and false negatives. Major and minor discrepancies were categorized for direct and indirect causes of maternal death. Analysis of 137 diagnoses in these 92 maternal deaths showed the lung was the most common site of discrepancy (78% were major), followed by the brain, liver, kidney, and heart. Acute respiratory distress syndrome (ARDS) and bronchopneumonia caused significant maternal death; 75% of ARDS cases had major discrepancies, mostly due to misdiagnosis as intrapulmonary hemorrhage or bronchopneumonia on gross examination. Discrepancies between gross and histopathologic findings reflect unavoidable diagnostic challenges due to inherent limitations of gross pathology, particularly with overlapping appearances.

Group A Streptococcus (GAS) is a gram-positive bacterium that causes a spectrum of illnesses, ranging from mild infections such as pharyngitis and impetigo to severe invasive diseases, including necrotizing fasciitis, streptococcal toxic shock syndrome, sepsis, and septic shock. Surveillance data from the United States and Europe indicate a marked post-COVID-19 pandemic increase in invasive GAS infections. At the Cook County Medical Examiner's Office (CCMEO), a retrospective review (2015-2025) identified 26 fatal GAS cases, with a significant surge in the postpandemic period. Postmortem diagnosis relies on cultures from sterile sites and histologic examination to confirm infection and minimize contamination artifacts. Most cases demonstrated rapid clinical progression, underscoring the high lethality of invasive GAS. As a secondary objective, postmortem pharyngeal swabs were collected in pediatric cases with suspected GAS infection and tested using a rapid antigen assay; all results were negative and confirmed by culture. These findings suggest the test may be useful for ruling out infection in negative cases, though the sensitivity in confirmed positives remains undetermined. This study highlights the essential role of forensic pathologists in detecting and documenting invasive GAS infections, thereby supporting public health surveillance, outbreak monitoring, and preventive strategies. Prompt recognition, accurate diagnostic sampling, and sustained vigilance are critical to reducing morbidity and mortality from this pathogen.

Homelessness remains a critical public health challenge that significantly increases the risk of premature mortality. Data from the Washington, D.C. Office of the Chief Medical Examiner were used to examine the mortality rates among undomiciled individuals between 2019 and 2023. This study focused on understanding how factors such as location, submanner of death, and decedent history contribute to overall mortality risk. Our analysis reveals that the Washington, D.C. mortality trends are consistent with observations in larger metropolitan areas and counties. The year 2020 emerged as the period with the highest mortality rate, and the rates demonstrated considerable fluctuations over the study period. In total, 712 deaths were recorded, predominantly among males and African Americans, with an average age of 49.4 years. Notably, intoxication-related fatalities accounted for 57.7% of deaths, with fentanyl being the most common contributing substance. In addition, a significant proportion of decedents had chronic health conditions or a history of substance use, underscoring complex underlying vulnerabilities. These findings highlight the necessity for enhanced mortality surveillance utilizing data from medical examiners and coroner offices to inform and refine public health initiatives and social programs aimed at mitigating preventable deaths among the undomiciled population.

Isobutyl nitrite is a malodorous chemical compound that is part of the larger group of alkyl nitrites. This group of chemicals is known to have potent vasodilation effects and, as such, was historically used to treat heart conditions like angina, though these have been replaced by other medications over time. Currently, alkyl nitrites are most frequently encountered as drugs of abuse, as inhalation of the chemicals induces vasodilation, creates a "head rush" and feeling of euphoria, and increases pleasure. While there is some toxicity associated with inhalation, it is generally not considered to be fatal. However, if the nitrites are instead ingested orally, the effects are much more profound, causing severe methemoglobinemia and potentially death. Reports of deaths due to nitrite ingestion are relatively rare overall and frequently are suicidal in nature. We report a death due to accidental ingestion of a vial of isobutyl nitrite with the aim of educating death investigators about the toxicity of this chemical, along with the pertinent autopsy findings and toxicology workup to aid them in the event they encounter such a case.

Determining the postmortem interval (PMI) is vital in forensic investigations but remains challenging due to the limitations of traditional methods. Proteomics offers a promising alternative by analyzing time-dependent protein degradation patterns. The systematic review explores recent advances in protein-based PMI estimation using animal and human tissues. The objective is to evaluate current research trends, highlight key biomarkers, and assess the potential of proteomic approaches for improving PMI accuracy and reliability. A total of 40 studies were identified across PubMed, Web of Science, Scopus, and ScienceDirect for publications from 2018 to 2024 using PRISMA guidelines, focusing on postmortem protein degradation for PMI estimation. Skeletal muscle was the most studied tissue, followed by bone, heart, and gingival tissues. Analytical techniques such as LC-MS and MALDI were widely employed, allowing detection and quantification of time-dependent proteomic changes. Despite promising results, variability in experimental conditions, tissue types, and lack of standardized protocols remain critical challenges. Proteomics offers a highly sensitive and specific approach for PMI estimation, enabling detailed molecular insight. While current evidence supports its forensic applicability, widespread adoption requires methodological standardization and integration of multimarker strategies. With refinement, proteomic profiling has the potential to transform PMI estimation into a robust, objective component of routine forensic investigations.

The New York City (NYC) Office of Chief Medical Examiner (OCME) continues to be severely impacted by the ongoing opioid overdose crisis with over 3000 overdose deaths in 2022 alone. The National Association of Medical Examiners (NAME) recommends that autopsies be performed in all suspected overdose deaths, but this practice is difficult to maintain in the face of an unprecedented number of overdose deaths and a national shortage of forensic pathologists. Using an existing database of suspected overdose deaths (SPOT) maintained by the OCME Drug Intelligence and Intervention Group (DIIG), we sought to assess the ability to correctly certify subsets of suspected overdose deaths based only on known history and circumstances, external examination, and toxicology testing (View-Tox) using 6 exclusionary criteria for View-Tox eligibility (suspicion of criminality, suicide, trauma, hypothermia/drowning, epilepsy/seizures, and death in a public location). This process resulted in the exclusion of all homicides, suicides, non-overdose accidents, and most undetermined manner deaths. Of the remaining cases eligible for View-Tox, 99.2% could be correctly certified based only on toxicology testing results and information known before autopsy. This approach to overdose deaths would have resulted in a 32.8% reduction of autopsies in suspected overdose deaths at OCME in 2022.

A Sinus of Valsalva aneurysm (SOVA) is a rare cardiac abnormality that involves the dilation or bulging of the aortic sinus(es). The symptoms of SOVA can be subtle and nonspecific, making the aneurysm difficult to detect before a possible rupture. When these aneurysms rupture, they are often fatal. In this case report, we present the sudden and unexpected death of a 36-year-old previously healthy male with no prior clinical history. Postmortem examination was notable for the unexpected finding of a multisinus SOVA with an atypical rupture into the pericardial sac resulting in a significant hemopericardium. An Arrhythmia and Cardiomyopathy and Aortopathy panel (Invitae Corp.) next-generation sequencing genetic testing was performed and revealed variants of unknown significance (VUS). This case report highlights an unusual presentation of SOVA in a young adult male and reviews the literature associated with this rare cardiac pathology entity. We also bring attention to the interpretation of ambiguous postmortem genetic testing results, including the importance of consent, cost, and access to genetic counseling. Postmortem genetic testing influences the living relatives of a decedent, and the autonomy of these individuals should be considered.

Railway-related fatalities present significant challenges to forensic pathologists due to extensive injuries and complex biomechanical factors involved. This retrospective observational study was conducted on autopsy cases involving 28 railway transection injuries, focusing on injury morphology and correlation with the body's position on the tracks. Among 28 railway injury cases, 8 had death scene photographs and circumstantial findings suggesting a suicidal manner of death and allowing evaluation of body position suitable for analysis and correlation. An abrasion collar was consistently observed in a suicidal transected wound at the wound margin. Five cases involved decapitation, 1 showed thoracic transection, 1 case involved both neck and bilateral thigh transections, and 1 case had a transaction at the back. The abrasion collar was always present on the portion in contact with the wheel flange (on the inner aspect of the rail), with varying width depending on anatomic site, pressure, and contact duration. In some cases, thermal effects and pressure, such as compression, scorching, or blackening and dehydration of tissues, were also observed. The mechanism and factors affecting the formation of the abrasion collar are discussed. The abrasion collar is a significant and valuable forensic marker that provides insight into body orientation and the dynamics of railway fatalities.

We recently investigated a death involving a drowning victim found in a slow-flowing part of a river with the right hand clutching a branch of bamboo growing along the bank. Such hand findings have traditionally been ascribed to cadaveric spasm, supposedly representing a stiffening of the muscles that occurs immediately after death. However, another persuasive opinion is that cadaveric spasm is a myth. A rational explanation for our case might thus be that the hand became flaccid immediately after death, but the bamboo branch remained close to the fingers under slow flow, and the subsequent onset of rigor mortis caused the hand to "grasp" the bamboo branch. However, another report of a drowning case described a blade of grass clutched in a hand despite a strong flow in an irrigation canal, which had swept the deceased 5.5 km downstream and stripped off all clothing. That case was difficult to explain without cadaveric spasm, and 2 animal studies have also shown the development of rigor mortis in a small proportion of animals immediately after death. We thus believe that cadaveric spasm deserves further consideration and should not yet be ruled out.

Central nervous system (CNS) tumors, though relatively uncommon in the general population, frequently cause significant morbidity and mortality in those affected. Although high-grade neoplasms specifically may prove rapidly fatal, the rarity of these neoplasms-as well as their nonspecific symptomatology-renders them easily mistaken for both more common and innocuous etiologies. We report a case of a 38-year-old female with no significant medical history who sought care after 1 week of blurred vision and pressure-like headache worsened by leaning forward. Following antibiotic and oral steroid therapy for suspected acute sinusitis, she was found dead at home 3 weeks later. Autopsy revealed a 4.5-cm hemorrhagic and necrotic mass arising around and essentially effacing the third ventricle, further obstructing the cerebral aqueduct and causing bihemispheric mass effect. Histologic and immunohistochemical workup demonstrated a high-grade IDH-wildtype diffuse glioma. In this report, we review the uncommon clinical circumstance in which untreated intracranial neoplasms can prove rapidly fatal, salient clinical examination features to recognize such a condition, and the suggestions and limitations of leading neuroimaging criteria and guidelines for patients presenting with headaches.

The Fourth Industrial Revolution has accelerated the integration of robotics and artificial intelligence (AI) into workplaces, creating opportunities to merge technology with real-world practice. In forensic pathology, workforce shortages and the dangers of investigating hazardous death scenes highlight the need for innovation. This study explored the use of a mobile, agile quadruped robot to investigate hanging death scenes, assessing its ability to navigate, capture evidence, and reduce human risk. The research focused on low-risk hanging death scenes as a starting point, with the aim of later extending to more hazardous environments such as chemical-related scenes, fire deaths, and mass disasters. The quadruped robot demonstrated advanced mobility, allowing routine inspection tasks and the collection of visual and environmental data with accuracy, safety, and frequency. The study reviewed existing literature on robotic applications in forensic investigations, developed an initial procedure for scene evaluation, and tested the approach on selected hanging cases. The findings discuss advantages, limitations, and lessons learned, offering insight into the potential role of robotics in forensic death scene work. While promising, technical and operational challenges remain before robotics can be fully integrated into routine forensic practice.

Carbon monoxide (CO) is a common agent of intentional poisoning due to its accessibility and perceived painless lethality. While most CO suicides result from combustion sources, the combination of formic and sulfuric acid represents a lesser-known but increasingly utilized method of CO generation through chemical reaction. This report describes the case of a 23-year-old male who died by CO inhalation inside a closed vehicle after mixing these 2 acids. The scene investigation revealed chemical containers and a suicide note; toxicological analysis showed 90% carboxyhemoglobin saturation and the presence of formic acid. An external examination noted cherry-red lividity and foam at the mouth. This case highlights a rare but growing method of suicide, as supported by a review of the literature identifying 17 fatal and 5 nonfatal cases. Reported carboxyhemoglobin levels ranged from 15.1% to 93.4%, with most decedents being young males. Acid vapors caused mucosal and dermal injuries in multiple cases, posing risks to bystanders and first responders. This report emphasizes the need for awareness of this emerging suicide method, recognition of its chemical hazards, and the implementation of appropriate safety protocols during scene investigation and forensic evaluation.

Thallium was widely used as a rat poison, but because of its high toxicity, it was banned from the market. Due to these limitations, its use for homicidal purposes has become a rare event over the years, and the biological signs of this fatal poisoning remain unclear and elusive, similar to the histologic lesions it induces. For this reason, we valuated it appropriate to report a specific and targeted focus on the microscopic pictures of this poisoning, given the uniqueness of the forensic case brought to our attention. In fact, not only were they 3 subjects who died of homicidal thallium poisoning, but also with different survivals, which made it possible to investigate the short and medium-term effects, currently completely unknown in the literature. In particular, both the signs related to the gastrointestinal transit of the toxic substance and the systemic ones due to its metabolization were documented, focusing mainly on viscera with high functional dignity and fully justifying the death of the victims. We therefore present the microscopic evidence that has emerged and discuss its forensic relevance, associating a complete and broad iconography, with the aim of enriching knowledge on this specific topic that is still little explored.