Volume 24, Issue 4 (October 1979)
Sudden Unexpected Death from Cardiac Concussion (Commotio Cordis) with Unusual Legal Complications
The clinical concept of cardiac concussion (commotio cordis) has been known for many centuries; however, it has received little attention since it was reviewed in the 1940s. Blunt force injuries to the chest wall causing damage to the heart are observed in injuries involving vehicular accidents, sports, and all activities entailing impact or crushing. Occasionally, little or no evidence of pathologic change is observed grossly or microscopically. The clinical course may depend on the degree of involvement of the conductive system of the heart, with death usually a result of ventricular fibrillation. Good clinical documentation of the events before death and a complete pathologic evaluation are necessary if the cause of death is to be determined. This paper reports a case of blunt force trauma to the anterior chest wall resulting in sudden death, unexpected legal complications arising from improper embalming of the body, and the pathologist's need to consider legal problems arising from his activities.