OFFICE OF THE DISTRICT MEDICAL EXAMINER

DISTRICT 15 – STATE OF FLORIDA

PALM BEACH COUNTY
3126 GUN CLUB ROAD
WEST PALM BEACH, FLORIDA 33406-3005
(561) 688-4575
(561) 688-4592 FAX

NAME: WILLIAMS, MARY CASE NUMBER: M22-00598

DATE OF DEATH: March 22, 2022 AGE: 58 SEX: Female RACE: White

DATE OF AUTOPSY: March 23, 2022 / 1010 hours

AUTOPSY FINDINGS:

1. Tension pneumothorax
a. Leftward mediastinal deviation (postmortem radiography)
b. Collapsed right lung
c. Parietal pleura defect of right costophrenic junction

2. Mild cerebral edema

3. Mild atherosclerotic coronary artery disease

4. Hepatic fatty metamorphosis

5. Nephrosclerosis

6. Status post liposuction and autologous fat reinjection

7. Status post implant explantation and mastopexy

8. Toxicology
a. Iliac vein blood: ephedrine, phenylpropanolamine, ibuprofen, lidocaine, trazodone,
O-desmethylvenlafaxine, diphenhydramine, hydroxyzine, promethazine, fentanyl,
cyclobenzaprine, hydromorphone, and cotinine
NAME: Williams, Mary CASE NUMBER: M22-00598

OPINION

CAUSE OF DEATH: Pneumothorax due to perforated parietal pleura during liposuction with
autologous fat reinjection procedure

MANNER OF DEATH: Accident

HOW INJURY OCCURRED: Parietal pleura was perforated during surgical procedure

Heidi Reinhard, M.D.

Associate Medical Examiner
Date Signed: 07/22/2022

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NAME: Williams, Mary CASE NUMBER: M22-00598

EXTERNAL EXAMINATION

The body is that of a well-developed, well-nourished, 5 foot 8 inch, 172-pound female that appears
the reported age of 58 years. The body is refrigerated, well preserved, and not embalmed. Fixed
lividity is on the posterior surfaces of the body, excluding areas exposed to pressure. An
appropriately labeled identification tag is attached to the left great toe.

The head is normally formed. The scalp has brown hair in a normal distribution. The corneas are
clear. The irides are brown. The sclerae are white-tan. The pale conjunctivae have no petechiae.
The external auditory canals are unremarkable. The nasal septum and nasal bones are intact. The
lips are symmetric. The oral cavity contains no obstructing debris or foreign material. The superior
and inferior labial frenula are intact. The maxillary and mandibular dentition are natural and in
good condition.

The neck, chest, and abdomen are symmetrical. The breasts are without palpable masses. The
abdomen is mildly protuberant and soft. The external genitalia are of an adult woman. The back
is symmetrical. The anus is patent and atraumatic.

The upper and lower extremities are symmetrical and have no deformities or palpable fractures.
The arms have no track marks. The wrists have no scars. The fingernails and toenails are intact.

IDENTIFICATION

The decedent is visually identified by the Jupiter Police Department via a Tennessee photographic
identification card.

EXTERNAL PERSONNEL PRESENT AT AUTOPSY

None.

CLOTHING AND PERSONAL EFFECTS

The decedent is clad in a green hospital gown.

EVIDENCE OF MEDICAL INTERVENTION

An intraosseous catheter is received adjacent to the body. The left third rib is fractured at the
costosternal junction and has associated soft tissue hemorrhage. The soft tissue of the anterior
mediastinum has focal hemorrhage. Two needle punctures and associated ecchymoses are on the
posterior aspect of the right hand. An identification bracelet is around the left wrist. An
invtravascular catheter is in the posterior aspect of the left hand.

EVIDENCE OF RECENT SURGICAL INTERVENTION

Tan, elastic bandages are around the torso and arms. The inferior aspects of the breasts have 10
centimeter, “L”- shaped incisions with surgical staples. The areolas have circumferential incisions

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NAME: Williams, Mary CASE NUMBER: M22-00598

with surgical staples. A 1.3 centimeter, sutured incision is on the abdomen, superior to the
umbilicus. A 1.2 centimeter, sutured incision is on the lower aspect of the abdomen, in the pubic
region. The right side of the chest, anterior to the right axilla, has two, 0.5 x 0.3 centimeter and 0.4
x 0.3 centimeter abrasions. The right side of the torso, near the midaxillary line, has three 1.0
centimeter, sutured incisions in the upper, middle, and lower aspects. The left side of the torso,
near the midaxillary line, has four, 1.0 centimeter, sutured incisions; two in the upper aspect, one
in the middle aspect, and one in the lower aspect. Drain tubes protrude from the right and left
inguinal regions and extend into the subcutaneous adipose tissue of the anterior aspect of the
abdomen. The lower aspect of the back, over the sacral region, has a 1.0 centimeter, sutured
incision. The left and right buttocks have 1.0 centimeter sutured incisions. The right arm has three
0.5 centimeter sutured incisions. The left arm has five 0.3 centimeter, sutured incisions.

The torso has diffuse, circumferential ecchymoses extending from the middle of the chest and
axillary regions to the region of the pelvis and hips. The underlying subcutaneous adipose tissue
is diffusely hemorrhagic and disrupted.

The costophrenic angle of the right pleural cavity has two, 0.4 centimeter and 0.5 centimeter,
defects with associated underlying soft tissue hemorrhage and adherent clotted blood. This defect
connects the disrupted, hemorrhagic adipose tissue of the right side of the back.

The adipose tissue of the right and left breasts has empty fibrous capsules.

POSTMORTEM RADIOGRAPHS

Full body radiographic images reveal lucency of the right chest cavity, a collapsed right lung with
leftward displacement of the mediastinum and the cardiac silhouette, radiopaque dental hardware,
surgical hardware of the cervical vertebrae and right ankle, and no acute osseous fractures.

INTERNAL EXAMINATION

All body organs are in their normal anatomic positions.

The reflected scalp has marked congestion. The skull has no fractures of the calvarium or the base
of the skull.

The dura mater has no discoloration, injury, or neomembrane. The 1392-gram brain is covered by
thin, transparent leptomeninges. There is no epidural, subdural, or subarachnoid hemorrhage. The
cerebral hemispheres are symmetrical; the gyri are slightly flattened and the sulci are narrow. The
gray/white matter junction is well demarcated. The cortical ribbon is of the same width
throughout. The white matter is without masses or areas of softening. The ventricles are not
dilated and unremarkable. The mammillary bodies are not shrunken or discolored. The
symmetrical hippocampi are not shrunken, scarred, or hemorrhagic. The cerebellar hemispheres
are symmetrical; the dorsal cerebellar vermis is not atrophic. The brainstem and proximal spinal
cord are unremarkable. The pituitary gland sits normally in the sella turcica.

The tongue has no bite marks or hemorrhage. The strap muscles and large vessels of the anterior

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NAME: Williams, Mary CASE NUMBER: M22-00598

neck are intact and unremarkable. The hyoid bone, thyroid cartilage, and larynx are symmetrical,
intact, and have no hemorrhages. The thyroid gland has a normal shape and brown-tan, glistening
parenchyma.

The upper airway, trachea, mainstem bronchi, and distal bronchioles contain tan, mucoid fluid.
The mucosal surfaces are smooth and red-tan. The right and left pleural cavities contain no excess
fluid collections or adhesions. The right lung is 247 grams and is collapsed. The left lung is 643
grams. The visceral pleurae of the lungs appear intact, tan-grey to grey-pink, smooth, and
glistening. The pulmonary parenchyma is tan-grey to maroon-red and has no masses, granulomata,
or areas of consolidation. The pulmonary arteries contain poorly formed, gelatinous clotted blood.

The 402-gram heart has smooth epicardial surfaces. The normally positioned ostia of the left main
and right coronary arteries are patent. The coronary arteries arise normally and follow a right
dominant distribution. Eccentric atherosclerosis produces luminal stenosis up to 10 percent in the
left anterior descending coronary artery. The left main coronary artery, left circumflex coronary
artery, and right coronary artery are patent. The four thin, pliable cardiac valves have no
deformities or vegetations. The tricuspid valve is 11.0 centimeters, the mitral valve is 12.0
centimeters, the pulmonic valve is 7.5 centimeters, and the aortic valve is 6.5 centimeters in
circumference. The mural endocardium is thin, smooth, and translucent. The red-brown
myocardium has no fibrosis, necrosis, or hemorrhage. The right and left ventricles are 0.4
centimeters and 1.4 centimeters thick, respectively. The interventricular septum is 1.3 centimeters
thick. The thin, elastic aorta has intimal fatty streaking and no atherosclerosis. The superior and
inferior vena cavae are intact.

The peritoneal cavity has no excess fluid or adhesions.

The esophagus is lined by gray-white, smooth mucosa, is not dilated or stenosed, and has no
varices. The stomach has a normal size and shape and contains approximately 50 milliliters of
dark brown fluid and partially digested food particles. The gastric mucosa is tan and devoid of the
usual folds. The small intestine has a normal length, configuration, and diameter and has a pink-
tan, smooth serosal surface. The mesentery has a normal insertion. The large intestine has a
smooth, pink-tan serosal surface and no palpable masses or obstructions. The appendix is
unremarkable.

The 1633-gram liver has an intact, smooth capsule covering tan to tan-yellow, soft parenchyma
with no masses or focal lesions. The extrahepatic and intrahepatic vessels contain soft, gelatinous
clotted blood. The gallbladder contains brown-yellow bile and is lined by brown-tan, velvety
mucosa.

The pancreas has tan, lobular parenchyma.

The 103-gram spleen has a gray-white, intact capsule covering maroon-red, soft parenchyma. The
lymph nodes of the neck, chest, abdomen, and pelvis are unremarkable.

The adrenal glands have yellow-tan cortices and brown-tan, liquid medullae.

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NAME: Williams, Mary CASE NUMBER: M22-00598

The right and left kidneys are 119 grams and 126 grams, respectively. The surfaces are maroon-
red and slightly granular. The parenchyma has well-defined corticomedullary junctions. The renal
vessels are patent. The renal calyces are not dilated. The ureters have a normal course and caliber.
The bladder contains a thin film of opaque, white-yellow urine and is lined by pink-tan, intact
mucosa.

The vagina, cervix, uterus, fallopian tubes, and ovaries are unremarkable.

The musculoskeletal system is well developed. The musculature has a normal, firm consistency.
The ligaments of the craniocervical junction are intact. The clavicles and sternum are intact. The
bone marrow of the ribs is maroon-red. The vertebral bodies of the cervical, thoracic, and lumbar
spine and the pelvic bones are intact. The veins of the right and left legs contain soft, gelatinous
clotted blood.

TOXICOLOGY

Iliac vein blood and vitreous fluid are sent to Axis Forensic Toxicology Laboratory for analysis.

MICROSCOPY (12 H&E stained slides; 3 Sudan black stained slides)

Brain – Brain parenchyma with mild edema and no other significant pathologic alteration. A Sudan
black stain is negative for intravascular fat deposits.

Clotted blood – The blood within the deep veins of the legs and pulmonary arteries is composed
of unorganized, non-layered aggregates of red blood cells, fibrin, and scattered aggregates of white
blood cells, consistent with post-mortem clots.

Lungs – The right lung is atelectatic. The pulmonary parenchyma has scattered hyaline membranes
and intraalveolar macrophages and neutrophils. The bronchial mucosa has submucosal edema with
scattered chronic inflammation. The intraparenchymal vasculature of the left and right lungs
contains unorganized red blood cell aggregates, consistent with post-mortem clots.

Parietal pleura – Mesothelial lined adipose tissue with scattered red blood cells and rare histiocytes.

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