Bronchial malformation as a cause of sudden, unexpected death - a plea forrequiring diagnostic autopsies

Background and objective: Legal regulations of cadaver examination and auto psy require fundamental changes. Regulations that result in up to 75% error s in the recorded cause of death on the death certificate make no sense. As an example, rare disease of bronchial malformation may cause sudden, unexp ected death but is only detectable at autopsy with subsequent histological examination. Patients and methods: In an series of 17.204 autopsies (from 1980 to 1999) 894 cases of sudden, unexpected death were examined. In 28 cases (3.1%) onl y histological examination of the lungs provided the cause of natural death . Results: Bronchial dysplasia may be clinically silent and leads to focal pa nazinar emphysema and atelectasis due to chronic air-flow obstruction and a n >>air trapping<< mechanism. Subsequent pulmonary hypertension results in a cor pulmonale, which may fail suddenly and unexpectedly. Conclusion: The diagnostic problems of natural death justifies the performa nce of an autopsy. This fact should be recognized legally. Using the exampl e of bronchial malformation, it is shown that only an autopsy may reveal th e exact cause of death.