解剖により病死と判明した車両火災の１例

Abstract

A woman in her 70s, with a history of lung c ancer, pancreatic cancer, and diabetes mellitus, was discovered deceased in the driver's seat of her car. She went out with her family in the morning but felt unwell and attempted to drive home. As she drove, the car burst into flames, prompting a passerby to call an ambulance. Her head and anterior surfaces of the extremities exhibited burns, with the thorax and abdomen showing III-IV degree burns on the anterior surface and I-II degree burns on the dorsal surface in some areas. There were fractures of the sternum, left clavicle, and bilateral ribs, and damage to the mesentery. Soot was observed in the trachea and bronchi, and examination revealed no traumatic changes in any viscera. The blood's carboxyhemoglobin (COHb) concentration was 15%. Histological examination indicated neutrophils in the blood vessels of the brain, heart, and liver, as well as neutrophil infiltration in the renal parenchyma. Consequently, the determined cause of death was a urinary tract infection. The chest severity rating, determined by the Abbreviated Injury Scale (AIS), was 6, signifying multiple rib fractures on both sides. The injury severity score (ISS), which is the sum of the squares of the highest AIS code in each of the three most severely injured body regions, was determined. The ISS score was 75 due to an AIS code of 6 for the chest. Generally, an ISS score of 25 or higher is associated with a high mortality rate. Consequently, even in the absence of the car fire, saving her life would have been challenging. Through this case, the importance of meticulous observation becomes evident, especially when histological examination is conducted during the autopsy of a burnt corpse.