KUMJ | VOL. 24 | NO. 3 | ISSUE 96 | JULY-SEPTEMBER, 2026

Histopathological Examination in Medicolegal Autopsies: Unmasking Early Myocardial Infarction in Two Cases of Sudden Death
Singh PK, Ojha P, Neupane S, Oli P, Rajak S, Simkhada S, Shrestha N

Abstract:
Sudden unexpected cardiac death remains one of the most challenging diagnoses in forensic pathology, particularly when gross autopsy findings are uncertain. Myocardial infarction in the first few hours after symptom onset may produce faint or absent gross morphological changes, making microscopic evaluation necessary. In Nepal, histopathological examination is not routine in medicolegal autopsies. We present two cases of sudden unexpected natural death involving middle-aged men who presented with nonspecific symptoms shortly before and were declared brought dead upon arrival at health care facilities. Medicolegal autopsies revealed minimal gross cardiac findings. First case, a localized whitish patch was identified over the right ventricular surface without significant coronary artery obstruction. Histopathological examination demonstrated early myocardial infarction involving the left ventricular wall and interventricular septum, accompanied by focal lymphocytic myocarditis and early coronary atherosclerosis. Second case, gross examination revealed severe calcific narrowing of the left anterior descending coronary artery. Microscopic examination confirmed early myocardial ischemic injury of the right ventricular myocardium with advanced atherosclerotic plaque characterized by cholesterol clefts and foamy macrophages. Routine histopathological examination should be strongly considered in medicolegal autopsies involving sudden unexplained deaths. Integrating microscopic evaluation into standard forensic practice improves diagnostic precision, reduces uncertainty in determining the cause of death, and enhances the scientific credibility of medicolegal investigations in resource-limited settings.
Keyword : Coronary artery diseases, Early myocardial infarction, Forensic pathology, Histopathology, Medicolegal autopsy, Nepal, Sudden cardiac death, Sudden unexpected death