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Washington University Experience | TRAUMA & FORENSIC | Contusions | 20A1 Contusions (Hx EtoH, NOS Case 20) 1

Case 20 History ---- The patient was a 63yo male with a history of stage III B cell lymphoma s/p chemotherapy, splenic rupture s/p embolization, paroxysmal atrial fibrillation, peptic ulcer disease, schizophrenia and depression who presented in the emergency department of BJH with abdominal pain, ascites and shortness of breath on 11/04. His EKG showed atrial fibrillation with no significant ischemic findings and a CT scan showed intra-abdominal and intrapelvic ascites, bilateral pleural effusions with left lower lobe consolidation, and an enlarged right heart with moderate tricuspid regurgitation. After few hours, his blood pressure dropped down below 90’s. The patient was started with IV fluids and antibiotics. However, his condition further worsened with abnormal electrolytes, hyponatremia, lactic acidosis and elevated liver enzymes. Despite supportive treatment, the patient eventually became unresponsive and was found to be breathless, pulseless and was pronounced dead on 11/05. The general postmortem exam failed to establish a cause of death. ---- At autopsy the weight of the unfixed brain was 1230g. 20A1,2 There are two brown-tan remote contusions (measuring 5 x 3 cm and 4 x 1 cm) on the right inferior frontal lobe and anterior aspect of the temporal lobe. It is possible that alcoholism indirectly resulted in the patient’s traumatic lesions, a common occurrence in such patients.

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