Bronchial malformation as a cause of sudden, unexpected death - a plea for requiring diagnostic autopsies

Background and objective: Legal regulations of cadaver examination and autopsy require fundamental changes. Regulations that result in up to 75% errors in the recorded cause of death on the death certificate make no sense. As an example, rare disease of bronchial malformation may cause sudden, unexpected death but is only detectable at autopsy with subsequent histological examination. Patients and methods: In an series of 17.204 autopsies (from 1980 to 1999) 894 cases of sudden, unexpected death were examined. In 28 cases (3.1%) only histological examination of the lungs provided the cause of natural death. Results: Bronchial dysplasia may be clinically silent and leads to focal panazinar emphysema and atelectasis due to chronic air-flow obstruction and an >>air trapping<< mechanism. Subsequent pulmonary hypertension results in a cor pulmonale, which may fail suddenly and unexpectedly. Conclusion: The diagnostic problems of natural death justifies the performance of an autopsy. This fact should be recognized legally. Using the example of bronchial malformation, it is shown that only an autopsy may reveal the exact cause of death.