A 72-year-old male, former smoker and moderate drinker, with no other relevant pathological history, was living on the streets.
Autopsy is performed 19 hours after death in accordance with recommendations for the harmonization of medico-legal autopsies by the Committee of Ministers of the Council of Europe [3].
Specifically, the protocol approved in the Subital Death Network was followed, including weight, height and abdominal perimeter of the cadaver; weight and macroscopic-microscopic examination of all organs as well as chemical-toxicological investigation.
Studies were conducted in the Department of Tenerife (pathological study) and Sevilla Department (chemical-toxicological analysis) of the National Institute of Toxicology and Forensic Sciences.
(a) Attendance at autopsy:
Talla 162 cm, weight 84 kg, abdominal perimeter 104 cm. Body mass index (BMI) = weight (kg)/[talla (m)]2 was 32 which means visceral obesity grade I with visceral obesity.
The external examination only revealed intense ceftazidime congestion.
In the internal examination, the lungs were increased in weight (D: 675 g, I: 490 g), with a pattern of congestion and significant edema.
Cardiomegaly of 485 g, being the average value expected according to body weight of 358 g (range 271-473 g) [6].
The free wall of the right ventricle had a thickness of 7 mm (range 2-7 mm) while the thickness of the left ventricle was 15 mm both in septum and free wall (range 10-15 mm).
Abundant myocardial infiltration of the right ventricle and posterior wall left ventricle a subepicardial 2.5 x 0.5 cm band extending from mesocardium to apex.
In the anterior wall of the left ventricle, another smaller area of fat mass of 0.5 cm in diameter was observed.
The coronary arteries were permeable and with few atheromatous plaques that determined luminal stenosis less than 25%.
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(b) Microscopic study:
The histopathological study, using Trichrome dye staining, showed abundant fatty infiltrate in the myocardium consisting of mature adipocytes among which islets of cardiomyocytes with normal structure and minimal interstitial fibrosis are observed.
The coronary arteries present fibrofatty plaques in the intima determining luminal stenosis not exceeding 25% (mild atherosclerotic).
No inflammatory infiltrate or signs of recent myocardial necrosis and/or repair fibrosis were observed.
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(c) chemical-toxicological analysis:
The general toxicological investigation detected the presence of ethyl alcohol at a concentration of 2.59 g/L.
