<p>Detainee, Nasef Jasem Ibrahim, died while in U.S. custody at Abu Ghraib prison. Mr. Ibraham, died of natural causes (Cardiac Tamponade as a result of Atherosclerotic Cardiovascular Disease). Mr. Ibraham was brought unconscious to one of the guard stations at Camp Ganci at the prison by his relatives. Once there the MP called for medics found Mr. Abraham was non-responsive and unconscious. They checked for vital signs with negative results and the prisoner was turning blue from the nipples up; pupils were fixed and dilated; no brachial or carotid pulse was detected. CPR was not initiated. The autopsy did not find any signs of trauma, bruising or other wounds.</p>
. . 1,1,:, "-.) I; ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner 1413 Research 'Blvd., Bldg. 102 Rockville, MD 20850 1·800..944-7912 FINAL AUTOPSY REPORT 6)(6)-4 Name: Autopsy No.: ME04-12 [ SSAN:~________~ .·AFIP No.: 2909183 Date of Birth: 1 JAN 1941 Rank: .Status Unknown Date of Death: 8 JAN 2004 Place of Death: Abu Ghraib, Iraq Date of Autopsy: II JAN 2004 Place of Autopsy: BIAP Mortuary, Date ofReport: 18 FEB 2004 Baghdad, Iraq Circumstances of Death: Iraqi detainee died while in U.S. custody. Authorization for Autopsy: Office of the Armed Forces Medical Examiner, lAW 10 USC 1471 Identification: Identification by accompanying paperwork and wristband, both of which include a photograph and identification number 154111CI CAUSE OF DEATH: Atherosclerotic Cardiovascular Disease Resulting in Cardiac Tamponade MANNER OF DEATH: NaMw AUTOPSY REPORT ME04-12 eI ,... FINAL AUTOPSY DIAGNOSES: I. Atherosclerotic Cardiovascular Disease A. Hemopericardium (650-milliliters) B. Rupture of the anterior 'wallofthe left ventricle C. Acute myocardial infarction D. Atherosclerosis of the coronary arteries, focally severe E. Arterionephrosclerosis F. Mild atherosclerosis of the aorta II. Pleural and Pulmonary Adhesions III. Enlarged, Nodular Prostate Gland IV. Toxicology is negative for ethanol, cyanide, and drugs of abuse '. AUTOPSY REPORT ME04-12 [b)(6}4 I EXTERNAL EXAMINATION The remains are received clad in a long brown outer garment, a blue vest, a white undershirt, khaki colored pants (outer), a white, pajama type pants. An identification bracelet that includes the decedent's name, photograph, and detainee number is on the left wrist. The body is that of a weU~developed,well~nourished appearing, 67 -inches, ISO-pounds (estimated) male, whose appearance is consistent with the reported age of63-years. Lividity is posterior and fixed~ exceptin ar~as exposed to pressure. Marked facial congestion is present. Rigorispassing. The body temperature is that· of the refrigeration unit. The scalp is covered with gray-black hair with male pattern balding. The corneae are moderately opaque. The irides are hazel and the pllpilsare round and equal in diameter. The external auditory canals are free ofabnormal secretions and foreign material. The earlobes are creased. The nose and maxillae are palpably stable. The teeth are natural and in poor condition, with several teeth partially or totally missing. Facial hair consists of a gray beard and mustache. The neck is mobile and the trachea is midline. The chest is symmetric. The abdomen is protuberant. The 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. Severe dry dermatitis involves both feet. The fingernails are intact. A Yz-inch acrochordon is on the posterior right thigh. A I Yz-inch scar is on the posterior right forearm. No tattoos or other significant identifying marks are present. MEDICAL INTERVENTION There is no evidence of medical intervention on the body at the time ofthe autopsy. EVIDENCE OF INJURY There is no evidence ofsignificant recent injury noted at the autopsy. INTERNAL EXAMINATION HEAD: The brain weighs 1450-grams. There is no epidural, subdural, or subarachnoid hemorrhage. Coronal sections demonstrate sharp demarcation between white and gray matter, without mass or contusive injury. The ventricles are of normal size. The basal ganglia, brainstem, cerebellum, and arterial systems are free of abnormalities. There are no skull fractures. No evidence ofnon-traumatic disease processes is noted. ~!;.;~ : --j rb I)(6}4 NECK: the thyroid cartilage and hyoid bone are intact: The larynx is lined by intact white rtiucosa~ The thyroid gland is slightly enlarged, symmetric, and red-brown; without cystic or nodular change. The tongue is free ofbite marks, hemorrhage, or other injuries. BODY CAVITIES: The ribs" stemwn, and vertebral bodies are :visibly and palpably intact. There is no abnonnal accumulation offluid in the pleural ·or peritoneal cavity. Scattered adhesions involve both lungs and the chest walL. The otgansoccupy their usual anatomic positions. The thickness.ofthe subcutaneous adipose tissue over the abdomen is 1 Y-i-inches. RESPIRATORY SYSTEM: The right· and left lungs weigh 850 and· 620-grams, respectively. The external· surfaces are deep red-purple with marked anthtacotic mottling. The pulmonary parenchyma is diffusely congested and edematous, without significant emphysematous changes. No mass lesions or areas ofconsolidation are present. The pulmonary arteries are unremarkable. CARDIOVASCULAR SYSTEM: The 410-gram heart is contained in an intact peri c ardial sac. There are 650-milliliters of clotted blood in thepericardial sac. The epicardial surface is smooth, with minimal fat investment. A I-centimeter in length,slit-like, irregular defect goes through the entire thickness of-the anterior wall ofthe left velltricle,l1~aI'.JlJ.e interventricular septum. A rim ofhemorrhage surrounds this defect. The coronary arteries are present in a normal distribution, with a right-dominant pattern. Cross sections of the vessels show near complete occlusion ofthe mid portion ofthe left anterior descending coronary artery by atherosclerosis. The other coronary arteries have only mild atherosclerot1c narrowing, up to 20%. The myocardium has patchy ·fibrosis. The valve leaflets are thin and mobile. The walls ofthe left and right ventricles are 1.3 and O.4-centimeters thick, respectively. The interventricular septum is 1.4-centimeters thick. The.endocardium is smooth. The aorta gives rise to three intact and patent arch vessels and has mild atherosclerosis. The renal and mesenteric vessels are unremarkable. LIVER & BILIARY SYSTEM: The 1640-gram liver has an intact, smooth capsule and a sharp anterior border. The parenchyma is tan-brown and congested, with the usua1.1obular architecture. No mass lesions or other abnonnalities are seen. The gallbladder contains 12-rnilliliters ofgreen black bile and. no stones~ The mucosal surface is green and velvety; The extrahepatic biliarytree is patent SPLEEN: The 320-gram spleen has a smooth, intact, red-purple capsule. The parenchyma is slightly soft, maroon and congested. /b)(6)-4 I PANCREAS: The.pancreas is:wdyelloW-tan, :witl1 (he ~sua,llo:bularar~hitecwre,andcl1ange& Ofearly autolYliis. No mass lesions or otherab~()nnali~ies art;? seen. . ADRENAL GLANDS: The right and left adrenal glands are symmetric, with yellow cortices, gray medullae, and alltolytic changes. No mass.es.orareas 9fhenlorrhage are identified. GENITOURINARY SYSTEM:. The tight and left kidneys weigh 190.and 175~grams, respectively. The ex~emal surfaces are intact with numerous pits, scars, and the characteristic "flea-bitten" appearance associated with poorly controlled hypertension. A 4-centimeter simple cyst is within the cortex ofthe right kidney. The cut surfaces are red-tan and congested, with blunted corticomedullary junctions. The pelves are unremarkable and the ureters are normalin course and caliber. White pladder mucosa overlies anintact bladder wall. 'The urinary bladder contains 50-milliliters ofdark yellow urine. The prostate gland is moderately enlarged, with lobular, yellow-tan parenchyma. The seminal vesicles are unremarkable. The testes are free ofmass lesions, contusions, or other abnormalities. GASTROINTESTINAL TRACT: The esophagus is intact and lined by smooth,grey-white mucosa. The stomach. contains approximately 40-mil1iliters ofdark tan fluid anq. partially digested food. rp.e gastric wall is intact The duodenum, loops ofsmall bowel, and colon are unremarkable, The appendix is present MUSCULOSKELETAL: No non-traumatic abnormalities of muscle or bone are identified. ADDITIONAL PROCEDURES • Documentary photographs are taken by OAFME phot9grapher PH3 Lolita Lewis, USN • Specimens retained for toxicologic testing and/or DNA identification are: vitreous fluid, cavity blood, bile, spleen, liver, lung, brain, kidney, urine, gastric contents, and psoas muscle. • The dissected organs are forwarded with body • Personal·effects and clothingarerele.ased to the mortuary personnel MICROSCOPIC EXAMINATION Selected portions oforgans are retained in formalin, without preparation of histologic slides. OPINION this .63-year.oldniale,EBl-"' .,.... l died as aresult of atherosclerotic cardiovascular disease resulting in cardiac tamponade; The autopsy revealed hemopericardium, with a rupture ofthe free wall ofthe left ventricle and focally severe atherosclerosis ofthe coronary arteries. Toxicologic studies were negative for ethanol, cyanide, and drugs of abuse~ The manner ofdeath is natural. )(B}2 CDR,MC, USN Chief Deputy Medical Examiner DEPARTMENT OF DEFENSE ARMED FORCES INSTITUTE OF PATHOLOGY WASHINGTON, DC 20306-6000 REPLVTO ATTENTION OF AFIP-CME-T PATIENT IDENTIFICATION AFIP Accessions Number Sequence TO: 2909183 00 Name OFFICE OF THE ARMED FORCES MEDICAL EXAMINER ARMED FORCES INSTITUTE OF PATHOLOGY SSAN: Autopsy: ME04-012 WASHINGTON, DC 20306-6000 Toxicology Accession #: 040164 Report Date: APRIL 6, 2004 CONSULTATION REPORT ON CONTRIBUTOR MATERIAL AMENDED REPORT AFIP DIAGNOSIS REPORT OF TOXICOLOGICAL EXAMINATION Condition of Specimens: GOOD Date of Incident: 1/8/2004 Date Received: 111512004 VOLATILES: The CAVITY BLOOD AND VITREOUS FLUID were examined for the presence of ethanol at a cutoff of20 mg/dL. No ethanol was detected. CYANIDE: There was no cyanide detected in the blood. The limit of quantitation for cyanide is 0.25 mg/L. Normal blood cyanide concentrations are less than 0.15 mg/L. Lethal concentrations of cyanide are greater than 3 mg/L. DRUGS: The BLOOD was screened for amphetamine, antidepressants, antihistamines, barbiturates, benzodiazepines, cannabinoids, cocaine, dextromethorphan, lidocaine, narcotic analgesics, opiates, phencyclidine, phenothiazines, sympathomimetic amines and verapamil by gas chromatography, color test or immunoassay. The following drugs were detected: None were found. b r)(S}-2 l PhD,DABFT Certifying Scientist, Forensic Toxicology Laboratory Director, Forensic Toxicology Laboratory Office of the Armed Forces Medical Examiner Office of the Armed Forces Medical Examiner MEDCOM -191 DOD 003318