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
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.