Coroner's report
Office of the Yoknapatawpha County Coroner |
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DATE and HOUR AUTOPSY PERFORMED: Manish Agarwal, M.D.
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Assistant: Victoria Witte, M.D.
Full Autopsy Performed |
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SUMMARY PRELIMINARY REPORT OF AUTOPSY |
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EXTERNAL EXAMINATION The autopsy is begun at 8:30 a.m. on November 23, 2013. The body is presented in a black body bag. When first viewed the deceased is clothed in black pants and jacket, maroon shirt, and black leather shoes. The body is that of a normally developed white female who appears 45-50 years of age and is of average nutritional status measuring 64 inches and weighing 178 pounds. Preservation is fair on the unembalmed body. The body is cold to the touch following refrigeration. The scalp is covered by brown hair with a maximal length of 43 cm. The eyes are closed. The irises are brown. The sclerae are clear. The pupils measure 0.4 cm. The scalp is unremarkable. Teeth are natural and in fair repair. The body hair is female and average. The neck is unremarkable. The chest is unremarkable as are the breasts. The abdomen is unremarkable. Limbs are equal and symmetrically developed. The back is unremarkable. The medical record is present. There are no residual scars, markings or tattoos. EVIDENCE OF TREATMENT An orotracheal tube is in place. Intravenous puncture sites are present in the right antecubital fossa and an intravenous line is present in the left antecubital fossa. EKG pasties are present on the upper torso. On the dorsal aspect of the left wrist, an intravenous line is present. AED pads are present on the sternum and left apex regions. INTERNAL EXAMINATION CAVITIES: Right and left pleural cavities are suffused with blood. CARDIOVASCULAR SYSTEM: The 235-gram heart has a dominant right coronary artery. The coronary vessels show focal mild artherosclerosis. Specifically absent are areas of discoloration with softening and fibrosis. RESPIRATORY SYSTEM: The lungs are unremarkable. The visceral pleura are unremarkable. The bronchial tree contains blood-stained fluid. Laryngeal and tracheal cartilages are intact and their mucosae contain blood-stained fluid. CENTRAL NERVOUS SYSTEM: The 1385-gram brain has unremarkable meninges. The vasculature of the basilar and cerebral arterial circulatory systems are unremarkable. With the dura removed, the base of the skull is free of fractures. URINARY SYSTEM: The 121-gram left kidney and 120-gram right kidney are similar. The pelvic calyceal system and ureters are unremarkable. The bladder contains 12 cc of urine. With this removed, the bladder wall is unremarkable. Microscopic hematuria is present. GENITAL SYSTEM: Fallopian tubes and ovaries are unremarkable. There is evidence of a previous subtotal hysterectomy. All organs are within normal limits. No underlying pathological disease conditions or congenital anomalies were observed. Examination of the pelvic area indicates the subject had not given birth. No evidence of sexual intercourse, forced or consensual, is noted. Vaginal fluid samples are removed for analysis. HEPATOBILIARY SYSTEM: The 1265-gram liver has an unremarkable capsule. The liver on section is uniform and dark brown. No masses are identified. The gallbladder contains 7 cc of thick green viscid bile. The extrahepatic biliary system is unremarkable. GASTROINTESTINAL TRACT: The esophagus is unremarkable. The stomach contains 6 cc of red liquid. The pancreas on section is uniform, gray-pink and moderately firm. The opened duodenum has neither food, ulcers nor masses. Externally, the small intestine, appendix and colon are unremarkable. LYMPHOPROLIFERATIVE SYSTEM: The 59-gram spleen has an unremarkable capsule. The parenchyma is moderately softened and dark red-brown. Abdominal and thoracic lymph nodes are unremarkable. MUSCULOSKELETAL SYSTEM: The musculoskeletal system is unremarkable and is within normal limits. TOXICOLOGY: Samples of central and peripheral blood, vitreous humor, gastric contents, urine, liver and bile are submitted for toxicologic analysis. SEROLOGY: A sample of right pleural blood is submitted in the EDTA tube. Routine toxicologic studies were ordered. DESCRIPTION OF INJURIES - SUMMARY HEAD AND NECK: The nasal bone is intact. Crusted blood is present at the nares. Crusted brown dried material is present within the mouth, on the lips. EXTREMITIES: A hematoma is present over the palmar and distal portion of the left arm of 5.3 x 4.2 cm. A blue-green/brown area of discoloration consistent with old hematoma is present on the proximal aspect of the right thigh, measuring 6.5 x 8.1 cm. TRUNCAL: The right suprailiac area there is a 4.3 x 8.2 cm hematoma. LABORATORY DATA Cerebrospinal fluid culture and sensitivity: Gram stain: Unremarkable Cerebrospinal fluid bacterial antigens: Hemophilus influenza B: Negative Vitreous sodium: 180 mmol/l Vitreous potassium: 13.9 mmol/l Vitreous urea nitrogen: 300 mg/dl Vitreous creatinine: 2.6 mg/dl Vitreous glucose: 15 mg/dl Vitreous chloride: 161 mmol/l Vitreous specific gravity: 1.337 Drug Screen Results: Urine screen {TLC-Basic} was positive for warfarin, which was later confirmed using GC-MS Urine screen {Immunoassay}:
Ethanol: .05 gm/dl, Blood (Heart) Ethanol: .03 gm/dl, Vitreous Millicent Schmid, Ph.D. EVIDENCE COLLECTED 1. One (1) women's blouse, maroon, short-sleeved 2. One (1) women's jacket, black, long-sleeved 3. One (1) pair women's black pants 4. One (1) pair women's shoes, black 5. One (1) pair women's underpants, black 6. One (1) brassiere, black 7. Samples of vaginal fluid 8. Samples of Hair, Blood (type A+), Bile, and Tissue (heart, lung, brain, kidney, liver, spleen). 9. Nine (9) autopsy photographs. 10. One postmortem CT scan. 11. One postmortem MRI. Clothing, hair sample, and blood sample transferred to Crime Lab for further analysis and comparison. OPINION Time of Death: Dr. Rebecca Kelleher pronounced death at 6:28 p.m. on December 22, 2013, at Baptist Memorial Hospital following unsuccessful resuscitation efforts. Immediate Cause of Death: Massive internal bleeding resulting in catastrophic multiple organ failures. Manner of Death: Pending investigation Notes: Medical records indicate the subject's warfarin treatment regimen had been terminated at the subject's request due to "intolerable side effects" five (5) months prior to death. The positive finding of warfarin at autopsy makes the death suspicious, and therefore, it requires further investigation.
//Manish Agarwal, M.D. |
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