The autopsy is not dead: ongoing relevance of the autopsy

Vignau, Alexia; Milikowski, Clara

doi:10.4322/acr.2023.425

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Sumário

Autopsy Case Report • Autops. Case Rep. 13 • 2023 • https://doi.org/10.4322/acr.2023.425 copy

The autopsy is not dead: ongoing relevance of the autopsy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Autopsy requests have been trending downward for a variety of factors. There are differences between pre- and postmortem diagnoses. Autopsies remain a tool for education, public health research, quality control, and closure for families.

Objective

We report two cases that illustrate the utility of autopsy for uncovering contributing factors in the death of these patients and highlight their ongoing importance.

Design

Clinical and autopsy investigation of two individuals and illustration of the importance of autopsy findings which, had they been diagnosed premortem, could have changed the outcome. Cases were evaluated using the Goldman criteria for discrepancies between premortem clinical diagnoses and postmortem autopsy findings.

Results

In the first case, the patient had been previously admitted due to a non-ST elevation myocardial infarction months before the fatal event. The autopsy showed an undiagnosed clear cell carcinoma of the ovary. She expired due to a massive myocardial infarction secondary to neoplasm induced hypercoagulable state. The degree of pre-mortem/postmortem diagnostic discrepancy makes this a Goldman Class I error.

In the second case, the patient presented to the emergency department with symptoms of Guillain-Barré Syndrome (GBS), for which he was treated. Abdominal masses were discovered; however, the patient decompensated before workup was completed. A high-grade B-cell lymphoma was confirmed but would not have altered the outcome, making this a Goldman class II error.

Conclusions

The autopsy remains a relevant and necessary tool for physicians and society. It assists in the establishment of diagnoses, measurement of treatment quality, the providence of public health metrics, and closure to the survivors.

Keywords:
Clear cell carcinoma of ovary; hypercoagulability; B cell lymphoma; Guillain-Barré syndrome

Goldman Classification	Requirements
Class I	Major discrepancy, where identification of diagnosis before death could have changed management and prolonged survival.
Class II	Major discrepancy in which identification of diagnosis would not have led to change in management/ survival.
Class III	Minor discrepancy where the disease was linked to terminal illness but ultimately did not directly cause death.
Class IV	Overlooked minor diagnoses that were important yet unrelated and could have eventually affected prognosis/outcome or a diagnosis that contributed to the passing of a terminally ill patient.

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’ contributions: Alexia Vignau was responsible for a substantial part of drafting the manuscript, literature review, revisions, and approval of final version to be published. Clara Milikowski was responsible for study design, guidance in manuscript preparation, major revisions of manuscript, revisions and approval of final version to be published.