Two Case Reports of Sudden Unexpected Death Resulting from Inflammation of the Sinoatrial node.

Korean J Leg Med. 2002 Oct;26(2):56-59. Korean.

Department of Forensic medicine, National Institute of Scientific Investigation, Korea. hjpark101@hanmail.net

Sudden unexpected deaths with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. In particular, no evidence of macroscopic cardiac abnormalities can be observed. However, extensive histologic screening including the cardiac conduction system may reveal anatomic abnormalities alleged to cause or contribute to sudden unexpected death. We report here two cases of sudden unexpected death in young persons (aged 32 and 43 years) who died of inflammation of the sinoatrial node. There was no cause of death despite a thorough autopsy, medical history and scene investigation. Their heart were slightly heavy (425 and 490gm, each) without significant coronary disease. So the portions of heart containing cardiac conduction system were excised and then studied microscopically. The two cases presented inflammatory process in the sinoatrial nodes consisting largely of lymphocytes, macrophages, and few neutrophils. There were no other histological abnormalities present. It was concluded that examination of the cardiac conduction system in deaths with no explanatory cause of death may provide an important information.

Key Words : Conduction system-Sinoatrial node-Sudden death-Arrhythmia