A 77-year-old man was admitted to a hospital due to a diagnosis of inflammatory bowel disease.
Treatment with intravenous steroids was started but the fever peaked and the limb venoclysis was changed due to phlebitis of the left upper limb.
In the 24 hours prior to death, all intravenous medication was withdrawn and oral steroid treatment was started.
During admission, the patient stood up from bed and walked normally.
In the first hour of the morning, it was found by the nursing staff in a situation of death with established lice and some rigidity of the upper limbs.
A judicial part of the death was sent when considering that it was a sudden-innocuous death whose cause was pending to be determined by the autopsy.
Venipunctures were observed in both upper limb flexions with hematoma and induration of the left cubital fossa.
Internal examination showed a thrombus with vital characteristics located in both pulmonary arteries extending into the right lung by all branches of the pulmonary artery to the right heart chambers and in the left lung almost clearly appreciated.
At the cut of the pulmonary parenchyma, embolic remains are seen within small vessels.
Areas of interstitial edema and pulmonary hemorrhage are also observed.
Both popliteal vascular bundles were dissected through the middle hollow popliteus, separating the muscle bundles of both twins, punctured artery and vein to be extracted.
Macroscopic examination showed no abnormalities.
Finally, we proceeded to extract the vascular bundle from the left cubital fossa presenting a reddish-dark coloration, thickening and hardening of the vein of the same package and the thrombotic formation.
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Examinations were performed in the Department of Sevilla of the National Institute of Toxicology and Forensic Sciences.
Chemical and toxicological analyses were negative for all substances studied.
Histopathological examination revealed generalized vascular congestion, mild coronary atherosclerosis with left ventricular hypertrophy and benign nephroangiopathy.
No significant histological changes were observed in both vascular popliteal packages.
The vascular bundle of the left arm showed signs of acute thrombophlebitis.
The lung showed congestion and edema, and fibrin emboli and some cells in the vessels.
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The medico-legal investigation determined that it was a sudden natural death caused by a massive pulmonary thromboembolism and that, given that there was no other focus, the origin of this thromboembolism in the left upper limb was established by exclusion.
