Diaphragm Pathology at Autopsy: A Survey
BS Fyfe, GT Butchy. UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
Background: Diaphragm pathology includes congenital, environmental, metabolic, inflammatory, degenerative diseases and (mal)adaptive states due to underlying cardiorespiratory disease and iatrogenic manipulations (mechanically assisted ventilation). However, the diaphragm may be not fully examined at autopsy. This study reviews the incidence of recorded diaphragmatic pathology at autopsy.
Design: A natural language search for the word diaphragm against autopsy reports was performed. This search identified autopsy reports indicating that section(s) of diaphragm were submitted for histology. For each identified case, the final report was reviewed. Diaphragmatic pathology was classified into congenital, metabolic, inflammatory, immune, neoplastic, degenerative, adaptive and environmental.
Results: 512 total autopsies were in the AP-LIS for 2003-2009. 34 cases documented diaphragm sections (fetal to 80 years). Eight cases were from patients less than one year of age. The spectrum of disease in these patients included reactive changes to bronchopulmonary dysplasia (2), congenital defects (one Pentalogy of Cantrell), inflammatory disease due to peritonitis/necrotizing enterocolitis (1), and diaphragmatic eventration due to neurogenic atrophy/phrenic nerve palsy (1). Three cases took diaphragm sections as part of routine microscopy. In the older age group metastatic malignancy was frequently represented (8 cases - 2 metastatic sarcoma and remainder ovarian, gastric and breast primary). Degenerative disease (1 Charcot Marie Tooth, 1 phrenic nerve palsy), reactive inflammatory disease (5), immune disease (1 scleroderma/dermatomyositis, 1 SLE), environmental disease(3 pleural plaques), congenital disease (1 diaphragmatic hernia), and one metabolic disease (unclassified mitochondrial disorder) were all represented in these cases. The remainder were cases of routine sections or patients with COPD and or mechanical ventilation.
Conclusions: The diaphragm may be involved in a wide array of disease states either primarily or as part of a systemic process. This muscle is not frequently studied at post-mortem examination (6.6% of cases with histologic examination). Pathologists need to be aware of the spectrum of diseases involving the diaphragm, routinely record normal variations of the muscle as well as any pathology. We now are modifying our routine autopsy reports to include an area for recording diaphragm measurements as well as any pathologic findings.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 12, Wednesday Morning