Death due post-traumatic myocardial infarction : a case of 14-years-old boy victims of a road accident

Introduction: Among the lesions brought back from victims of road accidents, traumatic myocardial infarction represents a wide studied occurrence in scientific literature that recognizes its maximum morbility in young people victims of thorax traumatisms. These cases are generally characterize by the absence of classic pathological conditions to the origin of the ischemic cardiopathy (coronary sclerosis and blood pressure alterations) or lesions of the coronary vascular walls (intimal lesions, dissections, thrombosis) that determine the myocardial damage by altering blood flow. In other cases it is the directed contusive myocardial trauma (contusio cordis) to provoke a progressive necrosis of the myofibrils, caused by the post-contusive local resentment. For other cases, it has not been still possible to find meaningful morphologic evidences. Methods: the heart of a 14-years-old subject, practicing agonistic sport activity, has been studied. He had been involved in a road accident (fallen from motorcycle), and had been recovered in a paediatric hospital unit because of the lesions reported. It was made diagnosis of left pulmonary contusion with pneumothorax, the opportune cures of the case were adopted and after 5 days in hospital the subject was discharged, with invites to carry out successive cardiologic controls because of a left bundle branch block finding. The same day the young subject died because of a cardiocirculatory arrest. Hystological examinations were conducted with usual techniques of paraffin inclusion and stained with hematoxylin-eeosin and special coloration (Masson’s trichrome). Results: the autopsy findings revealed an intrapericardial clot and transmural myocardial rupture, elastic coronaries without stenosis and identified the cause of death in heart rupture and tamponading hemopericardium during transmural myocardial infarction of the left ventricule posterior wall, without relief of vascular alterations. Hystological results proved, in the context of the post-traumatic infarction and heart rupture, focal morfological chronic aspects, similar to those observable in hypertrophic cardiomyopathy. Conclusions: in this case, the traumatic aetiology of the lethal myocardial infarction is confirmed by the presence of a thorax traumatism and the total correspondence between anamnesis, clinical informations and medico-legal evidences. The direct contusive effect of the cardiac structures injury played a key aetiological role: it caused pressure modifications of the thorax and movement of the heart against rigid structures of the body, in absence of traumatic lesions or thrombosis of the coronary walls or other ischemic myocardial pathologies located in different places from infarct rupture.