A 60-YEAR-OLD man had a history of hypertensive heart disease with congestive heart failure, chronic alcohol abuse, prior pontine lacunar infarcts, and remote head trauma from an auto accident that occurred 30 years before. He complained of decreased urine output and suprapubic tenderness and was admitted with a diagnosis of prostatism and possible pyelonephritis. About 24 hours following admission, he experienced a cardiac rhythm disturbance and a seizure and then died. Concern was expressed by the survivors that there had been some mistake on the part of the hospital staff or physicians since his death was perceived to be sudden. The medical examiner was notified but declined to investigate because of the patient's significant medical history. The permission to perform an autopsy was obtained from the legal next of kin.
Autopsy findings included prostatic hyperplasia with chronic prostatitis, hepatic steatosis with early cirrhosis, a 570-g heart with concentric