Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/52100
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Type: Journal article
Title: Megaesophagus and Possible Mechanisms of Sudden Death
Author: Schalinski, S.
Guddat, S.
Tsokos, M.
Byard, R.
Citation: Journal of Forensic Sciences, 2009; 54(1):216-219
Publisher: Amer Soc Testing Materials
Issue Date: 2009
ISSN: 0022-1198
1556-4029
Statement of
Responsibility: 
Sarah Schalinski, Saskia S. Guddat, Michael Tsokos, and Roger W. Byard
Abstract: Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66-year-old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84-year-old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease.
Keywords: forensic science; megaesophagus; achalasia; sudden death; aspiration; arrhythmia; mechanisms
RMID: 0020090031
DOI: 10.1111/j.1556-4029.2008.00912.x
Appears in Collections:Pathology publications

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