Alameda County"Sheriff's Office Gregory J. Ahern, Sheriff/ Coroner Coroner's Bureau, 2901 Peralta Oaks Ct, Oakland, CA 94605 (510) 382-3000 I (510) 382-3033 (fax) 0 u. z ...J u I Coroner Investigator's Report z w REPORTED BY PHONE NO. REPORTING AGENCY INVESTIGATOR CALL DATE AND TIME CASE TYPE (510) 437-4800 L. Shippey Rebecca Lorenzana HGT I I 4/29/2017 60 0 w w 0 I UNID REPORTED BY DATE AND TIME OF DEATH I- TENT VE ID � NAME OF DECEASED (LAST, FIRST MIDDLE) AGUILAR, Nestor Zarsuela WGT 155 15:36 EYE COLOR Brown I Removal Case 10/9/1953 Male GENDER AGE 63 Years OCCUPATION HAIR COLOR ·- I RACE I Filipino Certified Nursmg Assistant Black 2017-01400 Alameda Health System - Highland Hospit 4/29/2017 16:10 DATE OF BIRTH CASE NUMBER IFIED S EMPLOYER MARITAL STATUS Never Married ADDRESS (STREET, CITY, STATE, ZIP) 1411 E. 31 St Street Oakland CA 94602 0 Manner Cause A Cause B Cause C Cause D Natural � z z w 0 - I COUNTY Alameda Death Certificate Signed By: E. Bordi, Deputy Coroner Cardiac arrest Acute pulmonary embolism Interval Days Interval Days Interval Days lnterv:;il P' Clinical history of psychiatric illness. LEGAL NEXT OF KIN RELATIONSHIP TELEPHONE NO. NOTIFIED BY METHOD DATE AND TIME IDENTIFICATION METHOD DATE AND TIME Personal Identification LOCATION OF INCIDENT AT WORK COUNTY ADDRESS (STREET, CITY, STATE, ZIP) INV AGENCY PHONE NUMBER INVESTIGATING AGENCY Oceanview Cremations Full Autopsy � Partial Autopsy □ Inspection □ Record Review □ I (510) 667-3646 Alameda County Sheriffs Office-ETS OFFICER I BODY RELEASED TO FUNERAL HOME ON FUNERAL HOME Cl. Hospital - IP Hypoxic enceehaloeathy and diffuse organ failure Other Significant Conditions z □ LOD TYPE LOCATION OF DEATH w I VET? Preliminary Summary Alameda Health System - Highland Hospital J: � REFERENCE NUMBER Inspection w/Specimen □ Date Printed 5/3/2017 EXAM BY 14:04 Paul W. Herrmann Saturday, August 05, 2017 I □ DATE AND TIME OF INCIDENT Alameda County Sheriff?s Of?ce 7 Gregory J. Ahern, Sheriff Coroner Coroner's Bureau, 2901 Peralta Oaks Ct, Oakland, CA 94605 (510) 382-3000 (510) 382-3033 (fax) Investigator Narrative Decedent: AGUILAR, Nestor Case Number: - . 2017-01400 Investigator: RebecCa Lorenzana First Call Information: On Saturday, April 29, 2017, about 1610 hours, Dr. L. Shippey of Alameda Health Systems-Highland Hospital called and reported the undetermined manner of death of a 63year old male, Nestor Aguilar. Aguilar was transported to the hospital from Santa Rita Jail on Monday, April 24, 2017, by Alameda County Sheriff?s Deputies in a transport van. Upon arrival to the emergency room, Aguilar was unresponsive in the rear passenger area of the van. Medical personnel were summoned and they were able to resuscitate Aguilar. Aguilar was later transferred to the ICU where his condition Continued to deteriorate and he was-pronounced deceased today, April? 29, 2017, at 1536 hours. Dr. Shippey said Aguilar had no signi?cant medical history (Hypertension, Diabetes, and schizoaffective disorder) to explain his death and felt the injuries Aguilar sustained were questionable. However, a CT scan of his head showed no intracranial trauma. Dr. Shippey added Aguilar?s toxicology results upon admission were negative. Aguilar's next of kin were noti?ed of his death by Dr. Shippey. (RL1702) Medical Summary: Accordinf to Aguilar?s sister? Aguilar had a medical history of Aguilar was medicate or is conditions. -did not know the names cf the medications. According to medical records dated April 14, 2017, that I obtained from Santa Rita ail-California Forensic Medical Group (CFMG), Aguilar had ?allergies to medications included . Aim. socialnarymauaed?? and Aguilar had a mental diagnosis oi?Per Aguilar, On April 16, 2017, Aguilar was A chest may showca? . There were no in?ltrates, effusions, or pneumothorax seen. Alameda County Sheriff's Office 7 Gregory J. Ahern, Sheriff Coroner Coroner's Bureau, 2901 Peralta Oaks Ct., 7 Oakland, CA 94605 (510) 382-3000 (510) 382?3033 (fax) - On April 24, 2017, 1619 hours, it was noted Aguilar was evaluated by CFMG and he was extremely lethargic with unlaborcd breathing. Aguilar followed simple commands but was unable to get up or sit up. Aguilar would not eat or drink by himself. Aguilar had refused his medication for 2 days and was incontinent. Arrangements to transport Aguilar to Highland for treatment of altered consciousness and uncontrolled schizophrenia were made. (RL1702) Description of the Death] Injury Scene:- Aguilar was pronounced deceased 1n the Highland Hospital Intensive Care Unit, room 5509, located at 1411 E. 31St Street, Oakland CA, 94602. (RL1702) Body Identi?cation: - Aguilar Was personally identi?ed as Nestor Aguilar at the hospital by his sister,- I compared Aguilar to the photograph associated with the ConSolidated Records Information Management System (CRIMS) issued to Person F11e Numbe Nestor Aguilar The photograph and physical descriptors were a match to the decedent. (RL17 02) - On May 3, 2017, I received a fax from the Alameda County Sheriffs Office Central Identi?cation Bureau (CIB). A comparison was made between the decedent?s ?ngerprints and the . fingerprints associated with PFN (Person File Number) and name Nestor Aguilar (DOB: 10/09/1953) The fingerprints were identi?ed to have been ma by the same subject. Next of Kin Investigation: - - - Auilar was never married and had no children. A uilar? 5 1e a1 next of kin was his mother- - was noti?ed of Aguilar? 5 death hwas elderly and 1n poor health, so was authorized to handle Aguilar?s arrangements. exp alned the Coroner?s Bureau involvement and the need to contact a mortuary to-and she said she understood. (RL1702) . Other Agency Reports: There were no other agency reports associated with this case. (RL1702) Property and Evidence: Coroner?s receipt 38019 was issued for Aguilar and hospital specimens 'by Deputy Mendiola. Aguilar had no belongings with him at the hospital or at Santa Rita Jail. (RL1702) Alameda County Sheriff's Office Gregory J. Ahern, Sheriff Coroner Coroner's Bureau, 2901 Peralta Oaks Ct., Oakland, CA 94605 (510) 382-3000 (510) 382-3033 (fax) Coroners Fees: Removal and body preparation fees of$400 applied to this case. On May 3, 2017, the fees were paid in full by'Cooper?s Mortuary. Sheriff?s Technician S. Chun issued Accounting receipt 8538 to document the payment. A copy of the receipt was added to the case ?le. (RL1702) InVestigative Details: On Saturday, April 29, 2017, about 1730 hours, Sergeant R. Macintire noti?ed Lieutenant D. Vandagriff and Captain Hesselein of Aguilar?s death. About 1800 hours, I spoke with Lieutenant L. Delbridge from Santa Rita Jail and con?rmed he had been noti?ed of Aguilar?s death. (RL1702) Aguilar was housed alone during his stay at the Santa Rita Jail. There was no possibility that he could have been assaulted by another inmate. When Aguilar was arrested on April 12, 2017, the arresting Deputy utilized a full body restraint (WRAP) to 'move Aguilar because Aguilar became uncooperative by making his body limp and refused to walk on his own. There was no force used to put Aguilar in the wrap. Aguilar sustained no injuries. Aguilar was transported to Santa Rita Jail and booked. I compared Aguilar to his booking photograph to see if there was any trauma in the photo and saw none. The trauma reported by Dr. Shippey appearedsuper?cial and not signi?cant. The reported laceration on his lip was not present. There were super?cial abrasions to his face but they appeared old as they were scabbed. There was scabbing to his left knuckles that also appeared old. Some of the scabs had peeled and showed different layers of healing. I saw no evidence of obvious signi?cant trauma to Aguilar. (RL1702) On Saturday, April 29, 2017, about 1935 hours, Deputy J. Mendiola and M. Cardoza arrived at the Highland Hospital morgue to complete the removal of Aguilar. Aguilar was in the morgue, supine on a hospital gurney. Deputy Mendiola took photos of Aguilar to document his condition. Aguilar wore a hospital gown and medical therapy was in place. Aguilar was cold to thetouch. Livor mortis was present and consistent with his'supine position. Rigor mortis was present in the extremities. There was no signi?cant trauma seen. Aguilar had old scratches to his hands, leg and face. "Medical records and blood specimens were collected and Aguilar was moved to the Coroner?s Van without incident. On Sunday, April 30, 0135 hours, DeputyMendiola and Cardoza arrived to the Coroner?s Bureau and processed Aguilar into the morgue, which included intake photos. The photos were later downloaded onto a disk and added to the case ?le. Aguilar was measured at 60 inches tall and weighed 1551bs. Aguilar had black hair and brown eyes. (RL1702) On May 1,2017, Coroner?s Pathologist, P. Herrmann performed a complete autopsy on Aguilar. Aguilar?s cause of death was deferred for histology and toxicology results. (RL1702) Alameda County Sheriff's Of?ce Gregory J. Ahern, Sheriff Coroner Coroner's Bureau, .2901 Peralta Oaks Ct., Oakland, CA 94605 (510) 382-3000 (510) 382-3033 (fax) On May 8, 2017, Central Valley Toxicology, Inc. performed a complete drug screen on Aguilar?s blood obtained from the hospital. The screen revealed no common acidic, neutral or basic drugs detected. There was no ethyl alcohol detected. (RL1702) On June 27, 2017, Dr. Herrmann listed Aguilar?s cause of death to be due to Hypoxic Encephalopathy and diffuse organ failure due to cardiac arrest, due to acute pulmonary embolism. Another signi?cant condition listed was clinical history of illness. (RL1702) On July 3,2017, Dr. performed a histolo ical examination on A uilar?s' lungs, larynx, brain. In summa the lung showed The larynx showed ?mebramshowed tampon wasaddedtothe case ?le. (RL1702) Findings: On August 4, 2017, I reviewed this case to determine a manner in Aguilar?s death and to prepare this case for closure, Upon review of the case ?le, 1 determined Aguilar?s manner of death was natural. The toxicology test, histological examination, and autopsy results all showed Aguilar died of natural causes. The trauma that was seen on Aguilar was not related to his death and was most probably self in?icted, as. there was documentation that indicated Aguilar was witnessed to recently bang his head at a previous hospital visit. (RL1702) Supervisor Review: On Saturday, August 5, 2017, I (Sgt. Gonzalgo) reviewed this case and found it to be complete. I concur with the ?ndings and approve this case for Closure. (NLG5228) Alarnmla Cor mty Sh Of?ce am; Coroner?s Bureau . . 2901 Peralta Oaks Court, 2nd Floor, Oakland, CA 94605?5319 ?Kim1;-s (n egox I. A1161 1] Sher 1f} Director of Emergency Services Coroner - Marshal A DATE: May 1, 2017 FROM: Paul W. Herrmann, M.D. TO: Case File 2017?01400 SUBJECT: AUTOPSY PROTOCOL Autopsy performed upon the body of Nestor Z. Aguilar at the Coroner's Bureau, 2901 Peralta Oaks Court, Oakland, California, on May 1, 2017, at 9:10 a.m. AUTOPSY FINDINGS l) ALTERED BLOOD PRESENT THROUGHOUT THE ENTIRE LENGTH OF THE LARGE INTESTINE, NONE IS PRESENT IN THE STOMACH OR SMALL INTESTINE. 2) PALLOR OF THE BRAIN AND KIDNEYS. 3) CARDIOMEGALY WITH LEFT VENTRICULAR HYPERTROPHY (470 GRAMS). 4) MARKED CONGESTION OF THE LUNGS WITH AREAS OF CONSOLIDATION IN THE RIGHT LUNG AND WHAT APPEARS TO BE AN INFARCT IN THE LOWER LOBE OF THE LEFT LUNG. 5) TINY THROMBI SEEN IN THE PULMONARY FOCAL, RIGHT LUNG. 6) SMALL, OLD LESION IN THE RIGHT HEMISPHERE OF THE BRAIN NEAR THE BASAL GANGLIA. 7) HOSPITAL BLOOD SAMPLE: NO DRUGS DETECTED. 8) CLINICAL HISTORY OF HYPERTENSION, DIABETES MELLITUS, AND SCHIZOAFFECTIVE DISORDER. 9) HOSPITAL TOXICOLOGY TESTING 04/24/2017: NEGATIVE. Page 2 -Sheriff-Coroner Alameda County Body of NESTOR Z. AGUILAR 10) BLOOD GLUCOSE: 198 URINE GLUCOSE: NEGATIVE, ON HOSPITAL ADMISSION 04/24/2017. 11) CT ANGIOGRAPHY IN HOSPITAL 04/24/2017: PULMONARY EMBOLUS, RIGHT LOWER LUNG LOBE. CAUSE OF DEATH: HYPOXIC ENCEPHALOPATHY AND DIFFUSE ORGAN FAILURE DUE TO CARDIAC ARREST DUE TO ACUTE PULMONARY Other condition: CLINICAL HISTORY OF ILLNESS. Page 3 ?Sheriff-Coroner Alameda County Body of NESTOR Z. AGUILAR EXTERNAL The body is that of a well-developed adult male appearing consistent with the stated age of 63 years, weighing 155 pounds and measuring 60 inches. The hair is blackegray and is cut quite short. There is a black?gray mustache and goatee. The iridesare brown. Very slight arcus senilis is present. There is complete rigidity of the neck, no rigidity of the jaw, and complete rigidity of the extremities. Purple lividity is present on the back. There is the following evidence of MEDICAL TREATMENT: l) A protective gauze pad is in place over the sacral area. 2) Multiple EKG pads are adherent to the anterior torso. 3) A hospital?type identification band is present on the left wrist. 4) A bandage covers multiple needle punctures in the left antecubital fossa. 5) A bandage covers several needle punctures on the dorsum .of the left hand. 6) A hospital?type identification band is present on the right wrist. 7) A Foley catheter is present in the penis. It is attached to a urine collection bag that contains some urine. Page 4 Sheriff?Coroner Alameda County Body of NESTOR Z. AGUILAR 8) An intracath is taped in place on left side of neck. Paper bags cover the hands and wrists. When the bag is removed from the left hand, the fingernails are seen to be of moderate length and they are clean. There is-some healing trauma present on the dorsum of the left hand. When the bag is removed from the right hand, the fingernails are of moderate length and they are clean. Received with the body is'a plastic bag containing two vials of hospital?drawn blood, each dated ?04/24/17.? There is the following evidence of BLUNT TRAUMA: Several healing abrasiOns are present on the right side of the face. One of these is present juSt above the lateral rightr eyebrow. It meaSures 3/8 1/8 inch. Just above the eyebrow another area of healing abrasion measures 1/2 1/4 inch. Above the medial eyebrow by 1 inch, there is a healing abrasion measuring 5/8 1/4 inch. Within the left eyebrow laterally there is a 1/2 1/8 inch healing abrasion. One inch lateral to the outer canthus of the left there is a vertical abrasion measuring 3/4 1/8 inch. At 3/4 inch above the left lateral eyebrow there is a healing abrasion 1/2 1/8 inch. The right upper extremity shows no evidence of recent trauma and none is seen on the right hand. Page 5 Sheriff-Coroner Alameda County Body of NESTOR Z. AGUILAR There is no evidence of trauma to the neck. The chest shows no evidence of trauma. The abdomen shows a very faint in the right lower quadrant measuring l/2?inch in diameter and below that a 1/4 inch very faint is seen. In the left upper quadrant of the abdomen there are three very superficial scratch?type healing abrasions each measuring 3/16 inch in length. The left lateral abdomen shows a very faint measuring 1/2 inch in diameter. There is some suggestion of a needle puncture mark within this one and the two on the right side of the abdomen as well. There are what appear to be healing needle punctures in the left groin. On the medial aspect of the left knee there is a group of superficial abrasions healing abrasion within an area 4?1/4 inches vertically by 1?3/4 inches transversely. These I involve the epidermis only. A healing abrasion overlying the medial malleolus of the left ankle measures 1/4 inch in diameter. The left upper extremity shows an 4 inches below the left anterior axilla which measures 3/4 inch in diameter. There are two very superficial healing abrasions just above the left ulnar styloid each measuring 1/4 inch in length. .The dorsum of the left hand shows healing needle punctures, as Page 6 Sheriff?Coroner Alameda County Body of NESTOR z. AGUILAR previously described. There is a healing, somewhat scarred abrasion at the base of the dorsal left index finger that measures 1/2 1/4 inch. There is a healing lesion on the lateral aspect of the middle phalanx of the left index finger measuring 1/2 3/4 inch in length. 'These are quite old lesions. There is a healing abrasion overlying the proximal interphalangeal joint of the long finger and the ring finger each measuring 1/4 inch in diameter. -It shows scarring around its edges. and the same is true of the proximal interphalangeal joint of the little finger. Each of these lesions measure more than l/4?inch in size. The right lower extremity shows two healing abrasions lateral to the knee one measuring 1/2 and the other 3/8 inch in size. A healed, somewhat scarred abrasion is present in the pretibial area of the leg measuring 1 inch in length. There is a group of healing abrasions on the dorsum of the left shoulder in an area approximately 4?1/2 inches in greatest dimensions. These are very superficial scratch?type abrasions. INTERNAL EXAMINATION THORACQABDOMINAL AND INTERMASTOIDAL INCISIONS are made. Page 7 Sheriff?Coroner Alameda County - Body of NESTOR Z. AGUILAR 88 HEAD: There is no evidence of trauma to the scalp. The 89 subcutaneous tissue, galea and skull are unremarkable. The 90 meninges Show no abnormalities. The areas of the scalp beneath 91 the abrasions on the face do not show any contusion: The '.92 eXternal surface of the brain shows marked pallor and the gyri 93 are flattened. The unci are grooved. The 94 brain weighs 1300 grams.> Cut sections of the brain show no 95 abnormalities except for diffuse pallor and one area just 96 inferior to the right basal ganglia. This is a small somewhat 97 cystic area, measuring approximately 1/4 inch in diameter, with 98 brown discoloration of its edges. This may be an old area of 99 infarction. I doubt that it is an old area of trauma. The 100 remainder of the brain, the midbrain and the medullae show no 101 abnormalities. The cerebellum is unremarkable. The base of the 102 skull is unremarkable. The vessels of the base of the brain 103 show no abnormalities. I 104 NECK ORGANS: The soft tissues of the neck and the cervical 105 spine are unremarkable. The laryngeal and tracheal cartilages 106 and hyoid bone are intact. The airway shows marked edema of the 107 aryepiglottic folds and the inferior aspect of the epiglottis isr 108 also markedly edematous. There is an endotracheal tube in its 109 proper position. The thyroid gland is nodular but Page 8? Sheriff?Coroner Alameda County Body of NESTOR Z. AGUILAR 110 shows no other abnormalities. 111 CHEST: There are fractures of the right #3?6 ribs . 112' anterolaterally and on the left side the third, fourth and fifth 113 ribs are fractured anterolaterally with very little evidence of 114 hemorrhage.- The sternum is also fractured in the lower portion 115 without evidence of hemorrhage. These changes are consistent 116 with cardiopulmonary resuscitation. There is no free fluid in 117 the pleural cavities. The lungs fill the pleural spaces. 118 LUNGS: .The left lung weighs 500 grams. The right lung 119 weighs 750 grams. The left lung is markedly congested on cut 120 section. The right lung is markedly congested as well but there 121 are areas suggesting consolidation in the lower lobe and the 122 right upper lobe and in the left lower lobe there is an area of 123 hemorrhagic change which suggests an infarct just above the 124 diaphragmatic portion. This area measures approximately 3-1/2 125 inches in greatest dimensions. The pulmonary arteries and 126 bronchi show no abnormalities. There are no pulmonary emboli in ?127 ?the major vessels. In the right lung, however, on cut section 128 there are two small thrombi present within the pulmonary 129 'vasculature distally. These thrombi are depigmented 130 and measure no more than 1/4 inch in length and 1/8 inch in 131 diameter. Page 9 Sheriff?Coroner Alameda County Body of NESTOR Z. AGUILAR 132 HEART: The pericardial sac contains a small amount of 133 clear yellow fluid. The external surface of the heart shows 134 left ventricular prominence. The heart weighs 470 grams. The' 135 coronary arteries on cut section show no atherosclerosis. The 136 cardiac chambers and valves are unremarkable. The left 137 ventricular wall is thickened measuring 18?19 mm, the right 138 ventricle measures 4 mm. There is no evidence of any scarring. 139 'The foramen ovale is closed. The interventricular septum is 140 unremarkable in appearance. The descending thoracic and 141 abdominal aorta shows moderate atherosclerosis throughout its 142 length. 143 ABDOMEN: The abdominal fat is 1?1/2 inches at the 144 umbilicus. The organs are in their normal positions. 145 LIVER: The liver weighs 1900 grams. The capSular surface 146. is smooth. The on cut section shows a mild degree of 147 chronic passive congestion. The gallbladder and extrahepatic 148 ducts are unremarkable. 149 The spleen weighs 200 grams} The capsule is 150 smooth. The is firm and congested. 151 PANCREAS: The pancreas is of normal size. It_retains a 152 lobular architecture. 153 154 155 155 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171- 172 173 174 Page 10 Sheriff?Coroner Alameda County . .Body of NESTOR Z. AGUILAR ADRENAL GLANDS: The adrenals areequal in size. The medullae are dull brown and there is some lipid depletion of the cortices. I The mucosa of the esophagus and stomach is unremarkable.l The stomach contains approximately 40 cc of muCOid fluid. There is no evidence of any hemorrhage in the stomach. The duodenum and small bowel show no abnormalities. There is noblood present in the small bowel. The cecum shows the presence of altered blood and altered blood is seen throughout the entire length of the large intestine all the way to within approximately 2 inches of the rectum. .The bowel is opened and examined. and no eVidence of a lesion is seen in the large bowel mucosa. GENITOURINARY TRACT: The kidneys are equal in size weighing 180 grams each. The capsules strip with ease. The cortical surfaces are very granular with a number of small pitted scars. The on cut section is pale. The renal vessels, pelves and ureters are in their normal positions. The urinary bladder is empty. A Foley catheter is present in the bladder. The prostate gland is of normal size. The testes are palpated in the scrotum. The penis is uncircumcised. 175 176 177 178 179 180 181 Sheriff-Coroner Alameda County Page 11 Body Of NESTOR Z. AGUILAR The thoracic spine shows considerable osteoarthritis. MW PWH/jkm a.u 1W .'Herrmann, M. D. CENTRAL VALLEY TOXICOLOGY, INC. CVT-17-4948 Case Name: TOXICOLOGY NUMBER: Agullar, . Nestor . Hospltal samples: 3 ml blood (2 vials) each labeled Agullar, Nestor; MR 130502560; Specimen Description:DOB 10/09/1953; 522143858; 04/24/17; 2046 Delivered by Trio? Date 03-May-17 Received by Bill Posey Dat?03?May-17 Request: Complete Drug Screen I Agency Case 2017-01400 Requesting Agency Report To Alameda Co. Coroner's Of?ce Alameda Co. Coroner?s Of?ce Attn: Acct?s Payable Attn: Dr. Herrmann 2901 Peralta Oaks Ct., 2nd Floor 2901 Peralta Oaks Ct., 2nd Floor Oakland CA 94605 Oakland CA 94605 RESULTS Specimen: Hospital Blood (Gray Top Vial) Sample Complete Drug Screen: No common acidic, neutral or basic drugs detected. No Ethyl Alcohol detected. - 05 {fl/?01760 B.I.. POSEV KIMBLE Directors J7 I 1580 Tollhouse Road I Clovis. California 93611 Phone (559) 323-9940 B. L. Posey May08, 2017 Fax (559) 323-7502 Co mity ri {is ?ice Coroner?s Bureau f5 ?a?fib . 2901 Peralta Oaks Court, 2nd Floor, Oakland, CA 94605-5319 ?A'fa .- "1 1' . [li?i?gh?gg?ag I (Ire go 1' J. Ah ern, Sheriff 6. Director of Emergency Services Coroner - Marshal 2017-01400 Nestor Z. Aguilar PATHOLOGIST: Paul W. Henmann, M.D. HISTOLOGICAL EXAMINATION LUNG: Many alveolar macrophages with a number of alveoli showing a few polys. LARYNX: Submucosal edema and slight acute and chronic in?ammation. LUNG: A blood vessel shows a laminated blood clot which shows areas of ?broblastic proliferation within it. Near this blood clot some pneumonia can be seen within the of the lung and a number of alveoli show intraalveolar ?brin. LUNG: Scattered foci of acute pneumonia with acute bronchitis. LARYNX: Edema. BRAIN Focal area of dissolution of the with a number of iron-laden macrophages. Small blood vessels in this area show calci?cation within their walls and there is a prominent glial proliferation. PWH/jkm D: 06/26/17 T: 06/27/17 7/ MW MD. 5 Date I Signature .