Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report  

作　　者：Aniello Maiese Raffaele La Russa Mauro Arcangeli Gianpietro Volonnino Alessandra De Matteis Paola Frati Vittorio Fineschi 

机构地区：[1]Department of Surgical Pathology,Medical,Molecular and Critical Area,Institute of Legal Medicine,University of Pisa,Pisa 56126,Italy [2]Department of Anatomy,Histology,Forensic Medicine and Orthopedics,Sapienza University of Roma,Roma 00185,Italy [3]Department of Life,Health and Environmental Sciences,University of L'Aquila,L'Aquila 67100,Italy [4]Department SAIMLAL,Sapienza University of Roma,Roma 00185,Italy

出　　处：《World Journal of Clinical Cases》2020年第18期4128-4134,共7页世界临床病例杂志

摘　　要：BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

关 键 词：Sudden unexpected infant death Aspiration pneumonia Postmortem computed tomography Case report Diagnosis IMMUNOHISTOCHEMISTRY 

分 类 号：R725.4[医药卫生—儿科]