Critical care physician Dr. Michael Bergstein of Fairfield County Regional Hospital in Connecticut was flabbergasted when the long awaited autopsy specimen for his patient concluded “Insufficient Tissue, Consider Re-Sampling Lesion.”
Dr. Bergstein explained that a 39 year-old woman was admitted to the ICU in acute hypoxemic respiratory failure. She deteriorated rapidly and “our ER staff surprisingly had not ordered the CT-angio that is obligatory for all patients seen in our ED.” “We had little time act; sensing she may have had a pulmonary embolism so we pushed tPA but she ultimately died” he continued. The team later learned she was on OCPs, had a history of protein C and S deficiency, had completed an 8 hour plane flight, and has 3 sisters who had a PE. To better understand the case and autopsy was requested.
Dr. Rich Bubchewsky, the Chair of Pathology, performed the autopsy. “Cases like this are really complicated. Sure there was a massive clot in her pulmonary artery. But she had had an appendectomy when she was 8 years-old. We just didn’t have all the organs to make a definitive diagnosis .” Dr. Hal Orwin, another pathologist who assisted Dr. Bubchewsky, further added “There was tremendous crush artifact near the lungs likely from CPR. If the primary team wants an autopsy they should better consider how to preserve the tissue.”
Dr. Bergstein unfortunately had to explain the autopsy to the family. “Sometimes we just don’t know why someone dies” was the most he could share.