Rom J Leg Med [22] 233-236 [2014]
DOI: 10.4323/rjlm.2014.233
© 2014 Romanian Society of Legal Medicine Asphyxia death caused by epiglottic abscess rupture in an adult: A case report
Yong Cao1,2, Youjia Yu1, Xiaohong Gao3, Hong Jin4, Meigui Lu1, Daoyin Gong5, Feijun Huang1,*
_________________________________________________________________________________________
Abstract: We report a case of Asphyxia death caused by epiglottic abscess rupture. Patient was initially managed as acute
epiglottis with parenteral antibiotics, about two hours later, the patient died with bleeding from his nose and mouth. In this case,
the patient exhibited a hemorrhage at the top of the epiglottic abscess by the abscess surface mucosa rupture (0.5cm×0.1cm). We
reviewed this case with respect to the autopsy findings, pathological changes and circumstantial correlations of the investigation.
Key Words: epiglottic abscess, asphyxia death, autopsy, forensic pathology.
A
different category of blast injuries is the one
related with exploding tyres. Injuries caused
by exploding tyres can be seen as direct injuries caused
by rim fragments and barotraumas as a result of high
pressures [1].
A 47-year-old male was found dead at home with
a lot of blood flowing from his nose and mouth 2 hours
after leaving the hospital. From beginning to end, the
patient did not complain of expiratory dyspnea or show
sign of obstruction. The individual was pronounced dead
after emergency treatment in the hospital.
External examination revealed large amount of
blood in oval and nasal cavity (Fig. A). The fingernails
and toenails showed severe cyanosis and the external
auditory canal were normal. No lesion was observed on
the surface of body.
Autopsy revealed bloodstain on the surface of
epiglottis mucosa and throat (Fig. C, D), together with
edema of throat mucosa, epiglottis and surrounding
tissue. An epiglottic abscess nodule (1.6 × 1.3 × 0.6cm)
(Fig. E) was detected at the right side of the surface of
epiglottis.
The wall thickness of epiglottis was 1.0 cm (Fig.
G). Extensive epiglottis interstitial hemorrhage and
severe congestion of epiglottis were observed (Fig. C).
Large quantity of pink foamy liquid was retained in the
trachea and bronchi (Fig. B) and overflowed from the
lung section.
Microscopic investigation demonstrated diffused
hemorrhage in the epiglottis interstitial (Fig. H, I), large
number of neutrophils in the epiglottis abscess nodules,
granulation tissue around the abscess and congestion
of multiple tissues and organs. Severe lung congestion,
edema, focal hemorrhage and partial bronchospasm were
1) Department of Forensic Pathology, West China School of Basic Science and Forensic Medicine, Sichuan University,
3-17 Renmin South Road, Chengdu, Sichuan 610041, PR China
* Corresponding author: Tel.: +86-130-9632-6175, Email: [email protected]
2) Department of Pathology, Mudanjiang Medical University, Aimin District, Mudanjiang 157011, PR China
3) Biotechnology Laboratory, Mudanjiang Medical University, Aimin District, Mudanjiang 157011, PR China
4) Department of Clinical Laboratory, Hongqi Hospital, Mudanjiang Medical University, Aimin District, Mudanjiang
157011, PR China
5) Institute of Basic Medicine, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang
District, Chengdu, Sichuan 610000, PR China
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Cao Y. et alAsphyxia death caused by epiglottic abscess rupture in an adult: A case report
Figure. Autopsy revealed edema of epiglottis mucosa and surrounding tissue, hemorrhage of the epiglottic abscess surface and
a lot of pink foamy liquid in the bronchi. A. A large amount of blood in oval and nasal cavity; B. Pink foamy liquid in the
bronchi (white arrow); C and D. Severe laryngeal congestion and edema, epiglottis stenosis (white arrow); E. Epiglottic abscess
nodule measuring 1.6 cm × 1.3cm× 0.6cm (white arrow) at the right side of the surface of epiglottis; F. Epiglottic abscess rupture
measuring 0.5cm×0.1cm (white arrow).
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Romanian Journal of Legal Medicine Vol. XXII, No 4(2014)
Figure. G. The wall thickness of the epiglottis measuring 1.0cm (white arrow);H and I. The epiglottis interstitial diffuse hemorrhage
and inflammatory cell infiltration.
observed. Small amounts of hemorrhage were found in the
myocardial interstitial. Parts of the myocardial fibers were
wavy changed, small amount of fat cells and inflammatory
cells were observed in myocardial interstitial. There was
evidence of cerebral edema. The cause of death was
deemed suffocation due to airway obstruction caused
by epiglottic abscess rupture (0.5cm×0.1cm) (Fig. F),
bleeding and severe laryngeal edema.
Discussion
Acute laryngemphraxis refers to the upper
respiratory obstruction caused by various diseases
which induce laryngostenosis or obstructive breathing
difficulties. This symptom is more common in infants
and young children, and also occurs in adults. It is a very
critical condition that severe breathing difficulties would
take place in a short time. Without timely treatment,
some patients may die from suffocation. Many causes
may contribute to laryngeal obstruction, including
inflammation of the throat, allergic and certain systemic
diseases, inhalation injury (inhalation hydrothermal hot
toxic or irritating gases) etc [1].
About our case, five characteristics was
discovered by autopsy as follows:
The deceased had an epiglottic abscess nodule
(1.6 cm × 1.3 cm × 0.6cm) bleeding and laryngeal edema,
in which large number of neutrophils were found.
The deceased had focal pulmonary congestion,
edema, pulmonary hemorrhage, bronchospasm, etc,
which were consistent with acute myocardial ischemic
changes.
Multifocal hemorrhage in myocardial interstitial,
wave-like changes of multifocal myocardial fiber and
congestion of multiple tissues and organs were found. All
of them were consistent with signs of acute respiratory
and circulatory system failure.
No other lethal pathological changes and
mechanical traumas were found during autopsy.
The risk factors for epiglottic abscess include
age of onset, diabetes and the presence of foreign body
[2]. Berger et al. reported that 10 of the 116 epiglottitis
patients were diabetic, 16 of them had background disease
[3]. The clinical features of epiglottic abscess include
fever, odynophagia and hoarseness. Interestingly, airway
obstructions rarely become the presenting symptom as
compared to odynophagia and fever [4]. Therefore, CT
examination is recommended for patients with a stable
airway and swollen epiglottis, even if the swelling is not
very obvious [5].
Although some patients did not have any
symptoms of airway obstruction, the laryngoscopy
findings which showed severely narrowed supralaryngeal
airway warrant us to perform tracheostomy in order to
establish airway as well as provide route for administration
of anesthesia and drainage of the abscess. However, recent
report suggested other methods of treatment to avoid
tracheotomy. Kim SG et al. reported that 11 epiglottic
abscesses were successfully treated with spinal needle
aspiration that avoided the need for a tracheostomy [6].
At the same time, an iv antibiotics plus corticosteroids
should be administrated the moment a suspicion of
epiglottitis is present [7].
This case shows that in the course of clinical
diagnosis and treatment of patients with sore throat,
painful swallowing, the main symptoms of oropharyngeal
mucosa if no obvious lesions, especially, when some
patients do not complain of breathing difficulty or show
sign of obstruction, all of them should be routine for
indirect laryngoscopy to rule out the existence of acute
epiglottitis, epiglottis abscesses and other emergencies
adopted after diagnosis and effective treatment to avoid
serious complications.
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Cao Y. et alAsphyxia death caused by epiglottic abscess rupture in an adult: A case report
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