Autopsy No: ME04-110; Mohamad Abu Abbas, a 55 year old Iraqi male detained as a prison of war in Baghdad, Iraq, died in U.S. custody. Mr. Abbas had a history of ischemic heart disease, hypertension, hypercholesterolemia, and two possible previous myocardial infractions. On March 7, 2004, Mr. Abbas complained of chest pain and shortness of breath. He was brought to a medical clinic for evaluation where he became unresponsive. Emergency resuscitation efforts were unsuccessful. Cause of Death: Atherosclertoic Cardiovascular disease. Manner of Death: Natural.
ARMED FORCES INSTITUTE OF PATHOLOGY
·~ Office of the Armed Forces Medical Examiner
1413 Research Blvd., Bldg. 102
Rockville, MD 20850 1-800-944-7912
AUTOPSY EXAMINATION REPORT
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Narne: Autopsy No.: ME04-110
SSAN:. r AFIP No.: 2917882
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Date of Birth: 6 DEC 1948 Rank: EPOW
Date of Incident: 8 MAR 2004 Place of Death: Baghdad, Iraq
Date of Autopsy: 10 MAR 2004 Place of Autopsy: Baghdad
Date of Report: 10 MAY 2004 International Airport
Circumstances of Death: This 55-year-old male Enemy Prisoner of War had a history of ischemic heart disease. His past medical history includes hypertension, hypercholesterolemia, and possibly two previous myocardial infarctions. His medications included atenolol, Zocar, and aspirin, as well as sublingual nitroglycerin as needed. On the evening of 7 MAR 2004 he complained of chest pain and shortness of
. breath. He was brought to the medical clinic for evaluation where he became unresponsive. Resuscitation efforts, including Advanced Cardiac Life Support at a medical treatment facility, were unsuccessful.
Authorization for Autopsy: Armed Forces Medical Examiner, per 10 U.S. Code 1471
Identification: Identification is obtained by paperwork accompanying the body,
including a photograph with a matching prisoner number.
CAUSE OF DEATH: Atherosclerotic Cardiovascular Disease
MANNER OF DEATH: Natural
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ME04-110
FINAL AUTOPSY DIAGNOSES:
I. Atherosclerotic Cardiovascular Disease
A. History of ischemic heart disease
B. Cardiomegaly, marked (heart weight 620 grams)
C. Coronary atherosclerosis, focally severe
D. Diffuse myocardial scarring
E. Arterionephrosclerosis, mild
II. Marked Pulmonary Edema
III. Remote penetrating ballistic injury of the left buttock
A. Entrance: Inferior-medial aspect of left buttock (scar)
B. Wound Path: Skin, subcutaneous tissue, and muscle of left buttock, muscle of proximal left thigh
C. Recovered: Metallic foreign body encapsulated in fibrous tissue within muscle of proximal left thigh
D. Wound Direction: Left to right, back to front, and downward
IV.
Fractures of the 5th and 6th ribs on the right, associated with hemorrhage into chest wall musculature and abrasions/thermal injury of the chest (resuscitation efforts)
V.
Laceration ofthe nose and abrasion of the right index finger
VI. Toxicology is negative for drugs of abuse and ethanol. Lidocaine is present in heart blood.
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ME04-110
EXTERNAL EXAMINATION The remains are received clad in blue sweatpants and white boxer-type undershorts. Accompanying the remains but-not on the body are a light brown shirt, a white undershirt, and a wristwatch with a brown band. Black fingerprint powder covers the palmar aspect of all ofthe fingers as well as a large area on the mid anterior chest.
The body is that ofa well-developed, overweight, 75-inches, 225-pounds (estimated), White male, whose appearance is consistent with the reported age of 55-years. Lividity is posterior and fixed, except in areas exposed to pressure. Rigor is full and equal throughout. The body temperature is that ofthe refrigeration unit.
The scalp is covered with curly, brown hair in a normal distribution. The irides are brown and the pupils are round and equal in diameter. The nose and maxillae are palpably stable. The teeth are natural and in good condition. Facial hair consists ofa brown mustache and beard stubble.
The neck is mobile and the trachea is midline. The chest is symmetric. The abdomen is protuberant. The external genitalia are those ofa normal adult, circumcised, male. The testes are descended and free ofmasses. Pubic hair is present in a normal distribution. The buttocks and anus are unremarkable.
The upper and lower extremities are symmetric and without clubbing or edema. The fingernails are intact and short. There isa I Yz x %-inch irregular scar on the forehead, slightly left ofthe anterior midline. A Y4-inch pigmented nevus is on the anterior left flank. Numerous smallacrochordons are on the posterior neck. A 1 Y4x I-inch slightly pigmented area is on the anterior right hip. There is a I x Yz-inch area of hyperpigmentation on the medial.aspect ofthe proximal left thigh. A Yz x 3/8-inch ovoid scar is on the medial aspect ofthe lower left buttock. There are a few small irregular scars on the anterior aspect ofboth knees and al Y4-inch fine linear scar on the dorsal aspect ofthe right foot. No tattoos or other significant identifying marks are present.
MEDICAL INTERVENTION An endotracheal tube enters the trachea via the mouth. There are intravenous access devices in the right antecubital fossa and the dorsal aspect ofthe left hand. A 5 x 3-inch area ofabrasion and thermal effect is on the upper mid chest. There is a 6 x 4-inch area ofsuperficial abrasion and thermal effect with the outline of a defibrillator paddle on the upper left chest.
RADIOGRAPHS A complete set ofpostmortem radiographs is obtained and shows an absence ofskeletal trauma A metallic foreign body is in the proximal left thigh.
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EVIDENCE OF INJURY
I. Remote Penetrating Gunshot Wound to the Left Buttock Th~re isa well-healed Y2 x 3/8-inchovoid scar on the. medial aspect of the left buttock. Dissection ofthe posterior left buttock and left thigh reveals a \4
. inch in greatest dimension irregular metal fragment embedded. in a dense fibrous capsule located in the muscle of the proximal left thigh. The metallic foreign body is placed in alabeledcontainer and given to the investigating l;lgent. There is no hemorrhage associated with the wOurid path. The direction ofthe wound path isslightJyright to left, back to front, and slightly downward.
II. Other Injuries A horizonta13/8-'inch laceration through skin and subcutaneous tissue is across the bridge ofthe nose. A 1 x 1I8-inch superficial abrasion is on the dorsal aspect ofthe right index finger.
INTERNAL EXAMINATION HEAD: The brain weighs IS10-gramsand is remarkable for a I Y2 x I-centimeter soft, somewhat cystic area on the anterior pole ofthe left frontal lobe. This area is consistent with an old contusion and is not associated with any hemorrhage or other gross signs of acute injury. The skull directly overlying this area has a I.S-centimeter in diameter thinned area, consistent with remodeling secondary to a remote fracture. The scalp is umemarkable. There is no epidural, subdural, or subarachnoid hemorrhage. Sectioning ofthe brain reveals no other abnormalities. The atlanto-occipital joint is stable.
NECK:
Thethyroid cartilage and hyoid. bone are intact. The larynx is lined by intact white
mucosa. The thyroid gland is synunetricand red,.browil, withoutcystic or nodular
change. The tongue is free ofbite marks, hemorrhage, or other injuries.
BODY CAVITIES:
The vertebral bodies are visibly and. palpably intact. The ribs have injuries as previously
described. The pleural and peritoneal cavities have no abnormal accumulation of fluid.
There .are 20-milliliters ofserous fluid in thepericardial sac. There is no abnormal
accumulation offluid in the peritoneal cavity. The organs occupy their usual anatomic
positions. The thickness ofthe layer ofsubcutaneous adipose tissue over the abdomen is
1 %-inches.
RESPIRATORY SYSTEM:
The right and left lungs weigh 880 and.! 0;50-grams, respectively. The external surfaces
are smooth and deep red-purple, with moderate anthracotic mottling. The pulmonary
parenchyma is markedly congested and edematous. No mass lesions or areas of
consolidation are present. The pulmonary arteries are unremarkable.
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ME04-110
CARDIOVASCULAR SYSTEM: The 620-gram heart is containeci in an intactpericardial sac. The epicardial surface is smooth, with a moderately increased fat investment The coronary arteries, are present in a nonnal distribution, with a right-dominant pattern: CJ:oss sections ofthe vessels show focally severe calcific atherosclerosis .. The left main coronary artery.has.20% luminal narrowing. The left anterior descending coronary artery has up to.80%.luminal narrowing, most severe within the .proximal third ofthe vessel. A diagonalbran~his completely occluded. The left.circumflex.coronaryartery has 40% luminal narrowing, most severe in the proximal portion ofthevesseL. The right coronary artery is a large vessel, with 40% luminal narrowing, most severe in the middle third of the vessel. The myocardium is red-brown and finn, with diffuse fibrosis but no distinct scars. The valve leaflets are thin and mobile, except for one cusp of the aortic valve that shows mild calcification. The walls ofthe left and rightv:entricles are 1.5 and O.5-centimeters. thick, respectively. The interventricular septum is 1.4"-centimeters thick. . The endocardium is smooth and glistening. The aorta gives rise to three intact and patent arch vessels. There is mild atherosclerosis of the arch ofthe aorta, as well as the thoracic and abdominal aorta. The renal and mesenteric vessels are unremarkable.
LIVER & BILIARY SYSTEM:
The 2nO-gram liver has an intact, smooth capsule and a sharp anterior border. The
parenchyma is tan-brown and congested,. with the usual lobular architecture. No mass
lesions or other abnonnalities are seen. The gallbladder contains lO-milliliters ofgreen
black bile and no stones. The mucosal surface is green and velvety. The extrahepatic
biliary tree .is patent.
SPLEEN:
The 290-gram spleen has a smooth, intact, red-purple capsule. The parenchyma is firm,
maroon and congested, with distinct Malpighian corpuscles.
PANCREAS:
The pancreas is finn and yellow-,tan, with the usual lobular. architecture. No mass lesions
or other abnonnalities are seen.
ADRENAL GLANDS:
The right and left adrenal glands are symnietric; with bright yellow cortices .and gray.
medullae. No masses. or areas ofhemorrhage are identified.
GENITOURINARY. SYSTEM:
The right and left kidneys weigh 310 and 290-grams, respectively. The external surfaces
are intact, with minimal granUlarity and no pitting. The cut surfaces are red-tan and
congested, with uniformly thick cortices and sharp corticomedullary junctions. The
pelves are unremarkable and the uretersare.nonnal in course and caliber. White bladder
mucosa overlies an intact bla.,dder walL. The urinary bladder contains approximately 90milliliters ofyellow urine. The prostate gland is slightly.increased in size, with lobular,
yellow-tan parenchyma and a slightly nodular architecture. The seminal vesicles are
.. ' unremarkable. The testes are free of mass lesions, contusions, or other abnormalities.
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ME04-110
GASTROINTESTINAL TRACT:
The esophagus is intactand lined by smooth, gray~white mucosa. The stomach contains
approximately 15,"milliliters ofdark tan, viscous material. The gastric wall is . intact. The
duodenum, loops ofsmall bowel, and colon are :unremarkable. The appendix is present.
ADDITIONAL .PROCEDURES
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Documentary photographs are taken by aOAFME photographerPHCrbl(6~2USN· '----------'
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Evidence is turned over to the ArmyCJ.D. agent who was present during the· autopsy·
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Specimens retained for toxicologic testing and/or DNA identification are: vitreous fluid, heart blood, bile, spleen, liver, lung, brain,·kidney, and psoas muscle
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The dissected organs are forwarded with body·
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Personal effects and clothing are released to mortuary affairs personnel at Baghdad International Airport
MICROSCOPIC EXAMINATION
Selected portions oforgans are retained in formalin, without preparation of histologic
slides.
OPINION This 55-year-old White male,rI(6)4 ~ died as a result ofatherosclerotic cardiovascular disease. The autopsy disclosed marked cardiomegaly with focally severe calcific atherosclerosis ofthe coronary arteries, Additionally, a metallic foreign body from a remote penetrating ballistic injury to the left buttock was removed from the left thigh. The portion ofmetal was recovered, retained, and given to the investigating agent. Toxicological studies were negative for ethanol and drugs of abuse. The manner ofdeath is natural.
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Chief Deputy Medical Examiner
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