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Question #144 (3/20/2026)

National Association of Medical Examiners 
Educational Activities Committee

Submitted by Dr. Amy Tharp-Myers (District Chief Medical Examiner, Office of the Chief Medical Examiner, Western District Commonwealth of Virginia) and Caroline Collard, BS ( OMS-IV, Edward Via College of Osteopathic Medicine – Virginia ).
1.A 24-year-old man was dropped off at home from work around 1800 hours and later found unresponsive on the front porch at approximately 2300 hours by his roommate when he arrived home. The decedent was found supine with vomit next to him. EMS pronounced him dead on scene. Rigor mortis was present in his legs. He was transported to the Medical Examiner’s office for examination. No medical history was available at the time of examination.

Postmortem CT demonstrated cardiomegaly (560 g at autopsy) and no fractures or intracranial hemorrhages. Autopsy images (A-C) are shown.

Which of the following would be the most likely associated with this autopsy finding?