Forensic – Pathological SEM/EDX analysis in prosecution of medical malpractice

• Published in: Legal medicine (Tokyo, Japan) Japan), 2019-09, Vol.40, p.43-46
• Main Authors: Migliorini, Arnaldo Stanislao, Bailo, Paolo, Boracchi, Michele, Crudele, Graziano Domenico Luigi, Gentile, Guendalina, Zoja, Riccardo
• Format: Article
• Language: English
• Subjects: Autopsy; Bandages - adverse effects; Cardiac Surgical Procedures; Fatal Outcome; Female; Foreign Bodies - diagnostic imaging; Forensic pathology; Humans; Iatrogenic foreign body; Malpractice; Malpractice - legislation & jurisprudence; Microscopy, Electron, Scanning; Middle Aged; SEM/EDX analysis; Spectrometry, X-Ray Emission
• ISSN: 1344-6223; 1873-4162
• DOI: 10.1016/j.legalmed.2019.07.005

•Iatrogenic foreign body in mediastinum found after 14 years.•SEM/EDX analysis to understand the nature of the foreign body.•Responsibility in medical malpractice issues discussed. The retention of gauze within the mediastinum is considered an exceptional finding. We are presenting the case of a woman, affected by aorto-mitral valvulopathy, in whose mediastinum was found, during the autopsy, a gauzome without signs of active phlogosis, which had been “forgotten” in a previous surgery, acted 14 years before the death. A 39 y.o. woman had received surgical treatment of double aorto-mitral valve substitution and tricuspid plastic. At age 53, she successfully received surgery once again at a different hospital; she then started rehabilitation therapy, during which she deceased due to sudden hematemesis with infectious multi organ failure. During the autopsy, a 5 cm long surgical gauze was found in the mediastinum. A SEM/EDX (Scanning Electron Microscopy with Energy Dispersive X-ray spectroscopy) exam was ran on the foreign body and a sample of the same gauze used in the cardiac-surgical department of the hospital the victim had passed away in, to act a comparison between the two kinds of material. The exam showed a morphological difference between exogenous fibers incorporated within the gauzome and the control gauze. This case highlights the diagnostic and interpretative challenges in finding a foreign body within the mediastinum without signs of active phlogosis. SEM/EDX investigations executed on the gauzome and a “control gauze” allowed the attribution of malpractice to the first hospital the victim had been operated in 14 years before the exitus. The SEM/EDX exam confirms its importance in correctly identifying the case, which becomes an example for similar happenings.