Document 37ppZXagavm0zQjLDKVJ2yKx6

FILE NAME: RT Vanderbilt (RTV) DATE: 1997 Apr 24 DOC#: RTV046 DOCUMENT DESCRIPTION: Autopsy of Charles Forsyth with Asbestosis & Silicosis Listed 07- 14-97 10:42 315 464 7130 SUKY HSC PATHOL @ 002/006 S t i t t U a i r j I i y of Nw Y o r k Health Science Center at Syracuse U niversity H osp ital DEPARTMENT OF PATHOLOGY 10:52 F.R. DAVEY, MD, CHAIRMAN AUTOPSY REPORT NAME; FORSYTH,CHARLES UH#: 000195311 AUTOPSY NO.: A97-015 PATIENT NO.: AAP-3160 ATTENDING PHYSICIAN: WIDELL, JARED M SERVICE: ER CARDIOLOGY PROSECTOR: CHRISTINE FULLER, WITNESS: JOHN FALITIC DATE & TIME OF DEATH: 04/23/97 0857 DATE & TIME OF AUTOPSY: 04/24/97 0845 DATE OF REPORT: 05/26/97 M.D. FINAL AUTOPSY DIAGNOSIS 1. Acute myocardial infarction. 2. Chronic ischemic heart disease. 3. Early bronchopneumonia (left lower lobe). 4. Pneumoconiosis (Asbestosis and Talcosis) . a. Pleural plaques. b. Diffuse interstitial fibrosis (Grade 2-3 for histologic grading of asbestosis), . JER R O LD L . ABRAHAM, M.D. 314.00 750 EAST ADAMS STREET SYRACUSE. NEW YORK 13210 PHONE: (315) 464-4730 FAX. (315) 484-7130 07/l4'87 10:4 315 464 7130 SUNT HSC PAT1 0 L 1003/008 NAME: FORSYTH,CHARLES UH#: 000199311 AUTOPSY HO. : A97-015 PATIENT NO.: AAP-3160 MICROSCOPIC DESCRIPTION CARDIOVASCULAR SYSTEM-' Coronary arteries: Extensive atherosclerosis with focal dystrophic calcification (up to 90% occlusion of LAD and 50-70% occlusion of LCA and sight coronary arteries). HEART: Acute myocardial infarction (approximately 24 hours in age) with early myocyte coagulative necrosis (intense cytoplasmic eosinophilia and nuclear pytaiosia) and sparse neutrophilic infiltration. scattered areas of fibrosis and accompanying myocyte dropout (indicative of chronic ischemia). Numerous Hypertrophic myocytes. RESPIRATORY SYSTEM; Multiple pleural plagues - focally HYALINIZED and calcified collections of dense fibrous tissue with associated sparse lymphopxasmacytic infiltrates. LUNGS: Diffuse interstitial fibrosis most prominant in peribronchiolar areas, with 2 extension into respiratory bronchioles, alveolar ducts, and alveoli. Focal honeycombing is present. There is focal Type pneumocyte hyperplasia, with several pneumocytes containing cytoplasmic hyalin accumulations. Many asbestos bodies are seen, particularly within the lower lobes, embedded within the fibrous septae and also free within alveolar spaces (counts an one slide were 10+) . Abundant fine crystalline material which is weaJcly birfringent, is also present within the intersti titan, Early patchy broncho-pneumonia is seen within the left lower lobe. Mild emphysematous changes are noted focally. An iron stain best delineates the abundant accumulation of ferruginous bodies. Interstitial accumulations of strongly birfringent platy crystals consistent with talc are also noted. NOTE; the findings listed above would correlate with a Grade 2-3 for histologic grading of Asbestosis. Sections of pulmonary artery reveal moderate atherosclerosis. CHRISTINE "FULLER, M,D. JEBROLD L. ABRAHAM, M.D. B 1 4 ,00 07/14/97 10:42 t?315 464 7130 SUNY HSC PATHOL 004/008 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.R. DAVEY, MD, CHAIRMAN AUTOPSY REPORT NAME: FORSYTH,CHARLES UH#: 000199311 AUTOPSY NO.: A97-Q15 PATIENT NO.: AAP-3160 ATTENDING PHYSICIAN: WIDELL, JARED M SERVICE: ER CARDIOLOGY DATE & TIME OF DEATH: 04/23/S7 0857 DATE & TIME OF AUTOPSY: 04/24/97 0845 DATE OF REPORT: 05/13/97 PROSECTOR: CHRISTINE FULLER, M.D. WITNESS: JOHN FA1ITICO GROSS DESCRIPTION: The autopsy is performed approximately 24 hour after death. Permission is by the wife of the deceased. Authorization states heart and lungs only. EXTERNAL APPEARANCE: The subject is a 72 year old male. The body is well developed, well nourished and appears consistent with the stated age. The weight is 75 kilograms. The height is 5' 10". There is moderate rigor mortis, dependent lividity, and algor mortis. The skin is clear. There is a blue and black tattoo on the left forearm. The head is not deformed and there are no scars. The hair is sparse and gray and brown. The sclerae, cornea and Lenses are clear. The nose and external ears are unremarkable and their passages are clear. The lips and gums show no lesions and the patient is edentulous. The neck structures are symmetrical, and there are no unusual masses. There is a puncture mark in the right supraclavicular area indicative of previous catheter placement- The thorax has the normal contour and symmetry, and the male breasts and nipples are unremarkable. There is a 19.0 cm curvilinear well-healed thin scar in the left thorax. The abdomen is slightly protuberant. There are no abnormal masses or fluid wave externally palpable. There are two 1.0 cm and 11.3 cm healed scars slightly left of the midline- in the'mid epigastric region, as well a 21.0 cm scar that extends from zyphaid process to the pubic ramus. The testes are descended and there are no abnormal masses. No inguinal masses are palpable. There is an approximately 1.0 cm dark brown rough raised lesion in the left lower quadrant. Ecchyraoses are present in both antecubital fossa as well as on the dorsum of the right hand. There is also a small puncture mark in the right inguinal area consistent with a prior catheter placement. Extremities otherwise show no scars or deformities and there is minimal edema and moderate cyanosis in the lower extremities. 07/ 14/97 10:44 313 464 7130 SUNY HSC PATHOL @1006/006 04/25/97 10:52 DEPARTMENT OF PATHOLOGY F.R. DAVEY, MD, CHAIRMAN FORSYTH,CHARLES 000199311 AS7-Q15 AAP-3160 CLINICAL SUMMARY: The patient is a 72 year old male with a past medical history significant for a myocardial infarction at.the age of 40, congestive heart failure, diabetes, hypertension, asthma, and severe lung disease with occupational exposure to talc, (31 years), as well as a 40 plus pack year smoking history. On 4/22/97 at approximately 3:00 pm he complained of dizziness and experience of dyspnea. For several weeks prior to this event he had been experiencing severe exertional dyspnea and orthopnea. He was found unresponsive and cyanotic by his son-in-law who initiatad basic life support and called for paramedic assistance. Whan the ambulance arrived, the patient was found with agonal respirations and responsive only to noxious Stimuli. He was diaphoretic and a heart monitor revealed wide ventricular tachycardia. A finger stick showed a glucose level of 292. Ha was brought ta university Hospital emergency room where an ECG revealed wide complex tachycardia, right bundle branch block, and intermittent ventricular tachycardia. Examination revealed increased JVp, and bilateral pupils fixed and dilated. Antiarrhythmia drugs, including lidocaine, bretyllium, procainamide and magnesium (as well as IV dopamine) were begun. Echocardiogram showed severe left ventricular dysfunction, low ejection fraction (15%),and mitral and tricuspid regurgitation. Lab results included CK * 1099,CKMB = 17.5, CKMM = 4,6. He continued to be hemodynamical 1y unstable with blood pressures falling to 40/32 and heart rate in the low 30's. Additional lab results on the morning of 4/23/97 showed troponin = 8.2 and CKMB 28.5, and lactic acid = 12. The patient continued to deteriorate, and became unresponsive at 8:55 am on 4/23/97. DNR orders were in place, therefore no further resuscitation efforts were initiated. He was pronounced dead at B:S7 am by Dr. Nair.