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Dr. Alan Greene is the Chief Medical Officer for A.D.A.M. He is also on the Clinical Faculty at Stanford University School of Medicine, where he sees patients and instructs residents. He is a graduate of Princeton University and UCSF Medical School. He has had a powerful Internet connection with families around the world since co-founding DrGreene.com in 1995. He has conducted daily live chat sessions on the web for over three years. He is a founding member of Hi-Ethics (Health Internet Ethics). In 1999, Intel named Dr. Greene the Children's Health Hero of the Internet.

How Can The Cause of Death Be Determined?

Dear Dr. Greene:

I'm trying to understand a "Cause of Death" on my aunt's death certificate from 1931. She died at the age of 13 months in England in 1931.  On her death certificate, the cause of death is listed as:

"Cardiac failure due to excessive distension of the stomach in the presence of enlarged thyrrus and mediastical glands."

What does this mean?  Could she have had Graves' Disease or Thyroid (hypo) disease? Is it hereditary?

-- Thanks, Pamela

Dr. Greene: I love to hear about people researching the stories of their ancestors. This aunt who died at only 13 months had enlarged lymph glands in at least two places -- the thymus and the cluster of nodes in the center of the chest (the mediastinum). The pressure on the stomach suggests enlargement of the spleen as well (more lymph tissue) and perhaps the liver. This constellation of findings can be caused at that age by a pretty small number of diseases:

Malignancies -- T-cell lymphoma or leukemia are by far the most likely. Thymoma or teratoma are also possible. A neuroblastoma could do it, but would be less likely  to be found in the thymus.

Infections -- Tuberculosis would be the main culprit here. The other possibilities that often cause mediastinal swelling are coccidiomycosis or histoplasmosis, but neither was typically found in England at that time. Typhoid, rubella, varicella, or measles could also do it, but you would expect other findings as well - and probably mention of a fever and/or a rash.

Another possibility is sarcoidosis, an uncommon condition that is still not well understood. Sarcoidosis can cause swellings like those described. It is seen most commonly in young adults and older children, but it is possible in babies. It can run in families.

Your concern about thyroid problems, including Graves' disease, can be alleviated -- there is nothing in these autopsy findings to suggest them.

Created: 4/5/2001  -  Alan Greene, M.D., F.A.A.P.

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