Death Certificate - Lance, Delmas_5/17/1988' � GIBSON GENERAL HOSPITAL �
AUTOPSY REPORT
NAME: Lance, Delmus
AGE: 77
DATE OF DEATH: 4-17-86
AUTOPSY N0: 13A-86
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SEX: male
PHYSICIAN: Not dicta[ed.
DATE/PLACE OF AUTOPSY: 4-17-86 at 10 a.m. at Lamb and Hedges Memorial
Chapel in Oakland City, Indiana.
PATHOLOGIST: James A. Dennis, M. D.
AUTOPSY PERPIISSION: Granted by Artie Lance, wife of Delmus Lance,
deceased. Permission was given to perform an autopsy on the above named
person and the autopsy was limited to [he [horacic cavity for detection of
pneumoconiosis (black Lung).
GENERAL DESCRIPTIOC�: The body is that of a 77 year old Caucasian male
which measures approximately 5'10" and weighe approximately 200 pounds,
having normal developmen[ and normal nourishmen[. No livor mortis nor
rigor mortis is noted. The body has been embalmed at [he Lamb Hedges
Memorial Chapel by [he appropria[e techniques.
No ex[ernal marks of violence are seen. No fractures of extzemities are
noted, no lacerations, no contusions and no abrasions and no superficial
abnormalities are noted.
Gray thin hair is present on the scalp.
CLINICAL SUMMARY: This 77 year old man died as a result of respiratory
arrest that occurred at home and apparently was [he result of black lung
disease. The purpose of the autopsy is to determine the presence or
absence of black lung pathology.
PAST MEDICAL HISTORY: Black lung disease.
PAST SURGICAL HISTORY: Unknown at this time.
GENERAL DESCRIPTION: As above.
CARDIOVASCULAR SYTEM: The heart weighs approximately 350 grams and has a
rigt�t predominant coronary artery system. Coronary arteries show luminal
compromise greater chan 75%, particularly in the left an[erior descending
coronary artery.
Marked calcification is present. The right main coronary is daminant.
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LANCE, DELMUS
AUTOPSY N0: 13A-86
Page 2.
Sections through the myocardium reveal red-[an myocardium with irregular
splo[ches of fibrous connective tissue in several focal areas of the left
ventricular wall. The intraventricular septum also shovs red-[an
nyocardium.
The epicardial surface is glistening. The valve leaflets are thickened,
but semi-translucent and contain rolled edges. No insufficiency or
stenosis is noted. Calcification of the aortic akeleton is noted at [he
base of the hear[.
The aorta is intact. Atheromatous plaques are presen[ in the arch of [he
aorta.
RESPIRATORY SYTEM: Lungs are moderately heavy and show tracheobronchial
secretions consisting of frothy brown-tinged fluid.
The topography of both lungs is marked by black pigmen[ deposition,
heaviest in the apical areas and in the hilar areas. Hilar lymphadenopathy
is modera[e.
Cystic chsnge is presen[ in the apical portion of both lungs, moderate
degree, right greater than left.
Sections through Che tracheobronchial tree reveal marked congestion with
frothy fluid present in both lungs.
B1ack pigment accentuates the lobular architecture. The pigment
concen[rations are greatest in the hilar areas bilaterally and, also, in
[he apical areas bilaterally.
The limitation of the autopsy precludes fur[her examination and this
Examiner respects that request.
IMPRESSION:
CAUSE OF DEATH: ResFiratory arrest secondary to chronic obstructive
pulmonary disease with moderate degrees of emphysema and complicated by
black pigment deposition canpatible wi[h black lung pneumoconiosie.
SECONDARY DIAGNOSIS: A[herosclerotic cardiovascular disease manifeated by
calcifica[ion and luminal compromise of coronary arteries including the
left main coronary and the right coronary artery.
THIRD DIAGNOSIS: Hypertensive cardiovascular disease manifested by lef[
ven[ricular hypertrophy. �
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LANCE, DELMUS
AOTOPSY N0: 13A-86
Page 3.
DISCUSSION: This elderly gentleman met his demise as a result of
respiratory embarrassment secondary to the above stated pulmonary
pathology.
Microscopic evaluation will be determined to substantiate [he presence of a
pneumoconiosis, specifically black lung disease.
JAD/ 1 scv
D6T: 4-18/4-19-86
MICROSCOPIC DESCRIPTION
RESPIRATORY SYSTEM: Sections of the lung show a dense pleural and
subpleural deposition of anthracosilicosis pigment. The depoaition appears
to be confined predominantly to the in[erstitium and subpleural space. The
arterial component of the pulmonary vasculature shows thickening with
luminal canpromise and marked intimal thickening of [he medium sized
vessels and small vessels, in addition to the small arterioles. Venules
are intact for the most part. Moderate conges[ion is seen. Fragmen[s of
alveolar septi appear in luminal spaces with no at[achment to the adjacent
wa11s. One segment shows a dark dense accumulation of pigment surrounding
a vessel.
Macrophages are present in the alveolar spaces and show a dusky red
pigment. Individual alveolar septal walls are markedly thickened and
deposition of fibrous connec[ive tissue is noted there. The thickening of
these walls and focal areas of collapse along with the pigment deposi[ion
und the arterial changes indicate and support [he diagnois of chronic
obstructive pulmonary disease with an[hracosilicosis �black lung). The
presence of pulmonary conges[ion and edema is moderate. The subpleural
[hickening and the thickening of [he pleura with black pigment deposition
and marked thickening of the interseptal fibrous strains is diffuse.
Segments of the myocardium reveal branching of fibers and no acute
inflammatory infil[rate. The irregular fragmented branching fibers is seen
Chroughout the entire segment oE the septal muscle. Section of the leEt
ventricular free wa11 reveals branching fibers, enlarged nuclei and no
areas of acute infarc[ion.
A segment of the liver reveals marked fatty deposition. A generous
sprinkling of inflaffinatory cells is scat[ered throughout the liver.
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AUTOPSY H0: 13A-86
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Cen[ra1 veins are thin. Portal trac[s reveal a lymphocytic infla�natory
infiltrate. " � �
No bridging collapse is noted. No piecemeal necrosis is seen. The
liu�iting pla[e appears satisfactory. Liver cell cords are [c:o layezs
[hick.
Once again the marked fat[y deposition is no[ed.
SL"M:tARY 6 DISCUSSION: This patient died as [he result of pulmonary
problems presenting predominantly as a chronic obs[ruc[ive pulmonary
disease manifested by emphysema, centrolobular and panacinar. Black
pigment deposition compatible with anthracosilocosis and pulmonary fibrosis
is noted. Pulmonary hypertension was present as supported by thickening of
the arterioles.
In addition, the pa[ient had left ventricular hypertrophy and right
ventricular hyper[rophy with thickening of the intraventricular septum and
left ventricular wa11.
The pa[ien[, indeed, had black lung disease and severe restrictive
pulaonary disease evidenced by microscoNic sections Caken at autopsy.
D: 04-23-86
T: 04-24-86
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