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Question #133 (9/19/2025)
National Association of Medical Examiners
Educational Activities Committee
Submitted by Dr. Daniel Atherton, Medical Examiner and Associate Professor at University of Alabama Heersink School of Medicine.
1.
A 66-year-old man was found deceased on his couch. Autopsy revealed steatohepatitis, pulmonary emphysema, right ventricular hypertrophy and dilatation, and minimal atherosclerotic disease. The heart weighed 540 grams. Gross examination of the lower extremities revealed the findings shown in the photo.
What’s the mechanism for the appearance of the legs?
Arterial insufficiency causing tissue ischemia, inflammation and necrosis
Venous hypertension causing capillary leakage, inflammation, and poor oxygen delivery
Lymphatic obstruction leading to protein-rich edema
Peripheral neuropathy causing repeated unnoticed trauma
