DDx of Sudden Natural Death

· Cardiovascular disease

· Coronary artery disease (75% of all sudden natural deaths in adults)

· Cardiac arrhythmia usual mechanism

· Hypertensive cardiovascular disease

· Cardiac arrhythmia usual mechanism

· Cardiomyopathies

· Dilated cardiomyopathy

· Idiopathic

· Chronic alcoholism

· Peri- or post-partum

· Chronic or remote myocarditis

· Infectious

· Idiopathic

· Toxic / drugs

· Hypertrophic cardiomyopathy

· Hemochromatosis

· Other coronary artery abnormalities

· Coronary artery spasm (Prinzmetal angina)

· Muscular bridging of coronary artery

· Congenital anomalies

· Coronary artery hypoplasia

· Single coronary artery

· Left main coronary artery arising from the right sinus of Valsalva

· Right coronary artery arising from the left sinus of Valsalva

· Acute coronary artery dissection

· Arteritis

· Kawasaki

· Valvular disease

· Floppy mitral valve syndrome (myxoid degeneration of mitral valve / MVP)

· Arrhythmia is presumed mechanism

· Calcific aortic stenosis

· Endocarditis

· Marfan’s

· Myocarditis

· Infectious

· Toxic

· Inflammatory / connective tissue disorders

· Endocardium

· Endocarditis

· Fibroelastosis

·

· Rheumatic heart disease

· Vascular diseases:

· Aorta diseases

· Aortic dissection

· Syphilitic aortic aneurysms

· Coarctation

· Supravalvular stenosis

· Subaortic stenosis

· Aortitis

· Cystic medial necrosis

· Total anomalous pulmonary venous drainage

· Vascular malformations (esp. cerebral AV malformations)

· Pulmonary hypertension

· Other congenital cardiac defects

· Emotional stress

· Tumours

· Rhabdomyoma

· Fibroma

· Myxoma

· Conduction system disorders

· CNS disorders

· Epilepsy

· Intracerebral hemorrhage

· Hypertension

· Amyloid

· AVM

· Tumours

· Bleeding diatheses

· Drugs – cocaine, amphetamines

· vasculitis

· Subarachnoid hemorrhage (non-trauma)

· Ruptured berry aneurysm

· Arteriovenous malformation

· Meningitis

· Brain tumours

· Cerebral infarction

· Hydrocephalus

· Psychiatric disorders (schizophrenia)

· Infections

· Tuberous sclerosis

· Respiratory disorders

· Pulmonary embolus

· Asthma

· Pneumonia

· Epiglotitis

· Massive hemoptysis

· Neoplasms or inflammatory lesions of the nasopharynx

· Neoplasms of the bronchus

· Tuberculosis

· Abscess

· Bronchiectasis

· Aortic aneurysm

· Spontaneous pneumothorax

· Upper airway obstruction (congenital, infection)

· Bronchopulmonary dysplasia

· Idiopathic pulmonary hemosiderosis

· GI tract

· Massive hematemesis

· Esophageal varices

· Mallory-weiss

· Gastric or duodenal ulcer

· Strangulated hernias

· Pancreatitis

· Diabetes with DKA

· Gastroenteritis with electrolyte abnormalities

· Intestinal obstruction

· Intussusception

· Volvulus

· Congenital diaphragmatic hernia

· Hepatic disorders

· “fatty metamorphosis”

· Cirrhosis

· Massive intra-abdominal hemorrhage

· Adrenal disorders

· Phenochromocytoma

· Chronic adrenal insufficiency (Addison’s)

· Adrenal hypoplasia

·

· Splenic disorders

· Leukemia with splenic rupture

· Splenectomy history

· Or congenital asplenia

· Infectious mononucleosis with splenic rupture

· Hematologic disorders:

· Sickle cell trait

· Bleeding diatheses

· Hypercoagulable syndromes

· CS disease

· Lymphoma, leukemia

· Metabolic / endocrine:

· Fatty acid oxidation disorders (MCAD, LCAD)

· Carbohydrate disorders (galactosemia, glycogen storage disease)

· Amino acid disorders

· New onset diabetes mellitus

· Chromosomal disorders

· Down

· Fragile X

· Turner

· Miscellaneous

· SIDS

· Malnutrition

· Anorexia nervosa

· Ovarian torsion

· Reye syndrome

· anaphylaxis

References:

· DiMaio MVJ, Dana MSE. Handbook of Forensic Pathology. 2nd ed. CRC Press LLC; 2006.