Rare Case of Sudden Death Due to Hypotension During Cesarean Section in a Woman Suffering From Pheochromocytoma and Neurofibromatosis

• NCJ Number: 246259
• Journal: Journal of Forensic Sciences Volume: 58 Issue: 6 Dated: November 2013 Pages: 1636-1639
• Author(s): Rossana Cecchi M.D.; Paola Frati M.D.; Oriana Capri M.D.; Luigi Cipolloni M.D.
• Date Published: November 2013
• Length: 4 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

Sudden death following acute hypotension due to an undiagnosed pheochromocytoma PHEO is a rare event.

Abstract

Sudden death following acute hypotension due to an undiagnosed pheochromocytoma PHEO is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37-year-old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra-operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin-A CgA, CD20 antibody L26, anti-Keratocan antibody KER-1 and neuron-specific enolase NSE, and a PHEO-induced cardiomyopathy. The physiopathology of both stress-induced cardiomyopathy and PHEO-induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues. Abstract published by arrangement with Wiley.