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* Context.--Cardiac metastases are more prevalent than primary cardiac tumors, and although rare, the incidence is anticipated to increase with the extended survival of oncology patients. Objective.--To estimate the current incidence of cardiac metastasis from solid tumors in adult autopsies. Design.--Adult autopsy cases from 1984 through 2019 from patients diagnosed with any type of solid cancer were retrieved. The medical charts and pathologic autopsy data were reviewed in detail. Results.--A total of 1294 adult autopsies performed on patients diagnosed with any type of cancer within the past 35 years were reviewed. We found 124 secondary cardiac tumors. Eighty-five were due to cardiac involvement by solid tumors. Of these, 61 were true cardiac metastases of solid cancers. We focused on these 61 cases. The age range was 32 to 85 years. Forty-four patients were men and 17 were women. The lung was the most common primary site, with 21 cases (34.43%). The most frequent histologic type was carcinoma, with 54 cases (88.52%). The predominant layer of the heart involved was the pericardium, with 35 cases (57.38%). Twenty-one cases (34.43%) had pericardial effusion, with 4 being hemorrhagic. All cases had multiple extracardiac metastases, with 56 cases (91.8%) having distant metastases in 4 or more different organs. Conclusions.--Cardiac metastasis is a rare occurrence, with an incidence of 4.71% (61 of 1294 cases) in our series. Lung cancer accounted for most of the cardiac metastases seen, and carcinomas were the most frequent histologic type. The pericardium was the most frequent location. Cardiac metastases occurred most frequently in cases of massive metastatic dissemination. doi: 10.5858/arpa.2021-0418-OA, According to earlier autopsy studies, the frequency of primary cardiac tumors ranges from 0.001% to 0.3%. (1,2) Most primary cardiac tumors (~75%) are benign, with atrial myxoma being the most [...]

* Context.--This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting. Objective.--To accurately reflect the preexisting diseases and pathologic conditions of decedents with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection through autopsy. Design.--Comprehensive data from 135 autopsy evaluations of COVID-19-positive decedents is presented, including histologic assessment. Postmortem examinations were performed by 36 pathologists at 19 medical centers or forensic institutions in the United States and Brazil. Data from each autopsy were collected through the online submission of multiple-choice and open-ended survey responses. Results.--Patients dying of or with COVID-19 had an average of 8.89 pathologic conditions documented at autopsy, spanning a combination of prior chronic disease and acute conditions acquired during hospitalization. Virtually all decedents were cited as having more than 1 preexisting condition, encompassing an average of 2.88 such diseases each. Clinical conditions during terminal hospitalization were cited 395 times for the 135 autopsied decedents and predominantly encompassed acute failure of multiple organ systems and/or impaired coagulation. Myocarditis was rarely cited. Conclusions.--Cause-of-death statements in both autopsy reports and death certificates may not encompass the severity or spectrum of comorbid conditions in those dying of or with COVID-19. If supported by additional research, this finding may have implications for public health decisions and reporting moving forward through the pandemic. doi: 10.5858/arpa.2020-0786-SA, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged from Wuhan, China, in 2019 and has since created a global pandemic. (1,2) The spectrum of disease caused by SARS-CoV-2 infection in [...]

INTRODUCTION 1709 I. BACKGROUND 1716 II. DATA 1718 III. ANALYSIS 1721 CONCLUSION 1726 INTRODUCTION On February 13, 2016, Justice Antonin Scalia was found dead in his room at a ranch [...]

The number of major diagnostic errors detected by an autopsy has decreased since the 1960s, according to researchers who analyzed 45 studies published between 1966 and 2002. Nevertheless, the rate of major diagnostic errors revealed by an autopsy in 2002 ranges from 8% to 24%. This means that in 8% to 24% of all deaths, doctors were never able to diagnose the patient?s fatal illness before the patient died.

Autopsies of blunt and penetrating trauma deaths increased in the 1980s, but better reporting of autopsy findings is needed for them to be of use in improving medical care and public health. The frequency of autopsies of blunt and penetrating deaths increased from 51.5% in 1980 to 58.9% in 1989, while the overall frequency of autopsies dropped 23.6%. Among all deaths due to blunt and penetrating traumas, 96.9% of homicides were autopsied compared with 50.2% of non-homicides. Across the US, autopsy frequency of homicidal deaths due to blunt and penetrating traumas ranged from 79.6% to 100%, with 44 states having a rate of 90% or better. Autopsy frequency of non-homicidal deaths due to blunt or penetrating traumas ranged from 10.3% to 94.5%. The frequency of non-homicidal blunt and penetrating trauma deaths autopsied in metropolitan areas was 38.3% higher than in non-metropolitan areas. Better incorporation of autopsy findings - what are the causes and consequences of trauma and which deaths are preventable - could improve medical care., Objective.--To examine national trends in the percentage of blunt and penetrating trauma deaths autopsied. Design, Setting, and Participants.--For each year from 1980 through 1989, we used national mortality data files to determine the autopsy frequency (percentage of deaths autopsied) of all deaths in the United States. We analyzed variation in the autopsy frequency of blunt and penetrating trauma deaths by cause of injury and place of occurrence of death. Results.--The autopsy frequency of blunt and penetrating trauma deaths in the United States increased by 14.3% during the 1980s to 58.9% in 1989 (62 004 of 105 309 deaths autopsied), while the autopsy frequency of all deaths decreased by 23.6% during the same period to 11.5% in 1989 (248 272 of 2 153 859 deaths autopsied). Among trauma deaths, homicides remained far more likely to be autopsied than nonhomicides (deaths due to unintentional injuries, suicides, and injuries of undetermined intentionality). The autopsy frequency of homicidal trauma deaths in 1989 was 90.0% or higher in 44 states and ranged from 79.6% in Mississippi to 100.0% in six states. The autopsy frequency of nonhomicidal trauma deaths in 1989 was 90.0% or higher in two states and ranged from 10.3% in Oklahoma to 94.5% in Hawaii. Nationwide, we found significant differences in the autopsy frequency of trauma deaths in 1989 between metropolitan and nonmetropolitan counties, both for homicides (97.7% vs 89.3%; P Conclusions.--The percentage of blunt and penetrating trauma deaths autopsied has increased recently in the United States, but extensive geographic variation in autopsy frequency suggests that the benefits of autopsy findings for trauma care quality improvement and public health surveillance of injuries are distributed unevenly throughout the nation. (JAMA. 1993;269:1525-1531)

Determining the number of cases of an illness in a given population has traditionally been done through screening surveys of living subjects. A new tool for determining disease prevalence is the epidemiologic necropsy, or autopsy survey. One disease entity so studied was the abdominal aortic aneurysm (AAA), which involves a ballooning and thinning of the walls of the aorta, the body's largest artery, as it passes through the abdomen. These aneurysms are a not uncommon cause of death, but their prevalence in the population in general is unknown. A series of over 7,000 autopsies from the same hospital, in cases where no diagnosis of AAA was suspected, were reviewed to determine how frequently AAA was diagnosed after death. The autopsy detection rate of AAA in men was 81 of 4,155, and in women, 28 of 3,142. A comparison of these results with ultrasound screenings of living populations revealed similar prevalences of unsuspected AAA. The validity of epidemiologic autopsy as a research tool is still to be determined. These preliminary results suggest that such autopsy reviews will be useful, but more must be done, involving hospitals in different geographic areas, to determine if the epidemiological technique will reveal the true incidence of disease in given populations. (Consumer Summary produced by Reliance Medical Information, Inc.)

In 1950, the autopsy rate in the United States was 60 to 80 percent, but by 1980 it had fallen to 10 percent. A similar decline has taken place in Britain. Autopsy is often considered irrelevant, may be poorly performed by untrained personnel, and the results may not be made available for several months. Physician interest has dwindled, and fear of litigation based on autopsy results has increased. Also, physicians mistakenly believe that the precision of modern techniques of clinical diagnosis have made autopsy superfluous. Finally, autopsies are considered expensive, and the method of payment is not clear, although the cost to the hospital is largely the ''fixed'' cost of staff and physical plant. Autopsies have revealed that the major clinical diagnosis was incorrect in 20 to 30 percent of cases, involving a treatable condition in about half of these, a proportion that has not changed since 1950. The types of undiagnosed disorders have changed over the years, with unusual infections and pulmonary emboli (clots in the lungs) now the most commonly missed diagnoses. Information about the correct diagnosis in the 30 percent of misdiagnosed cases is valuable, and accurate information is vital to statistical analysis of mortality. In order to study the usefulness of autopsies in Britain, 108 autopsies were performed. Errors in diagnosis or treatment were found in 8 percent, complications resulting from treatment in 9 percent, and missed diagnoses were found in 14 percent. There was a high rate of unsuspected diagnoses, and autopsy was considered helpful in over half of all the cases. Monthly conferences presenting short descriptions of two or three major cases would be useful. Not only is this informative for the staff, but it has improved the performance of autopsies because of the likelihood that the case will come up for discussion. (Consumer Summary produced by Reliance Medical Information, Inc.)