Brody School of Medicine at East Carolina University Division of Forensic Pathology ECU Brody School of Medicine

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1 Brody School of Medicine at East Carolina University Division of Forensic Pathology ECU Brody School of Medicine Dept of Clinical/Forensic Path Greenville, NC Telephone Fax REPORT OF AUTOPSY EXAMINATION DECEDENT Document Identifier B Autopsy Type ME Autopsy Name LuAnn Perry Ambrose Age 59 yrs Race White Sex F AUTHORIZATION Authorized By Jonathan W. Kelly EMT-P Received From Bertie ENVIRONMENT Date of Exam 03/29/2017 Time of Exam 14:22 Autopsy Facility ECU Brody School of Medicine Persons Present Richard Hodges, PA; Jennifer Sosebee; Special Agent Joseph Bode and Interns Hailey Crawley and Paige Kirby of North Carolina State Bureau of Investigation CERTIFICATION Cause of Death GUNSHOT WOUND OF THE HEAD. The facts stated herein are correct to the best of my knowledge and belief. Digitally signed by Karen L. Kelly MD 01 September :56 DIAGNOSES I. Gunshot wound of the head: A. Massive basilar skull fractures with hemorrhage. B. Cerebral contusions and lacerations. C. Blood present along airway surfaces. II. Marked diffuse thermal injuries: A. Pugilistic posture. B. Destruction of scalp and calvarium. C. Absence of soot on tongue, in oropharynx, along trachea or within distal bronchi. D. Blood carbon monoxide saturation: <5% (negative). E. Body circumstances and family description of absent anterior right lower tooth. III. Cardiovascular system: A. Atherosclerotic coronary artery disease: 1. Right coronary artery, 95-98% narrowed by atherosclerotic plaque (right dominant pattern). 2. Anterior descending coronary artery, 90-95% narrowed by atherosclerotic plaque. 3. First diagonal coronary artery, 90-95% narrowed by atherosclerotic plaque. 4. Circumflex coronary artery, occluded by atherosclerotic plaque and organized thrombus. B. Systemic atherosclerotic vascular disease: 1. Right brachiocephalic artery, 50-75% narrowed narrowed by atherosclerotic plaque. 2. Right subclavian artery, 90-95% narrowed by atherosclerotic plaque. 3. Left common carotid artery, 90-98% narrowed by atherosclerotic plaque. 4. Right renal artery, occluded by atherosclerotic plaque and organized thrombus. 5. Left renal artery, 95-98% narrowed by atherosclerotic plaque. C. Moderate aortic atherosclerosis. Page 1 of 6 F September :56

2 IV. Additional findings: A.Respiratory system: 1. Bilateral pulmonary emphysema. 2. Pulmonary arterial hypertension. B. Cholelithiasis. C. Two splenic infarcts. D. Cortical adrenal nodule. E. Toxicology: Negative for ethanol. EXTERNAL DESCRIPTION Length 42 inches Weight 49 pounds Body Condition Charred Rigor The body is in a typical pugilistic posture. Livor Livor mortis cannot be assessed. Hair Scalp and facial hair cannot be assessed. Eyes The eyes cannot be assessed. Teeth The edentulous upper jaw is covered by a denture. The anterior teeth over the lower jaw are in good repair. The following description excludes the later-described injuries. The body is that of an unembalmed adult female whose age and race are difficult to assess. The anterior skin surfaces of the torso are intact. The posterior right upper and mid-back and both buttocks have intact skin surfaces. The anterior surfaces of the right upper arm are intact. The body is warm to touch. INJURIES I. GUNSHOT WOUND OF THE HEAD: The basilar skull is massively fractured with hemorrhage. There are areas of possible cerebral contusions and lacerations along the wound track. II. THERMAL INJURIES: The scalp and soft tissues of the face are charred. Both eyes, the nose, soft tissues surrounding the mouth and both external ears are destroyed. The scalp and upper portions of the calvarium are destroyed. The lateral left chest wall shows loss of skin, subcutaneous and muscle tissues and the left rib cage with exposure of the left lung and heart. The pericardium and epicardium are charred. The left lung is diffusely charred posteriorly. The right lung is charred diffusely. The loss of tissue in the area of the lateral left abdomen shows exposure of the spleen. The splenic capsule is diffusely charred. Destruction of the tissues of the right back exposes the underlying liver. The right liver lobe is diffusely charred. The right kidney and adrenal gland are charred. Both lower extremities are destroyed below the mid-thighs. The right upper thigh shows loss of skin, subcutaneous and muscle tissues with exposed bone. The left upper thigh shows loss of skin and subcutaneous tissue with exposure of underlying muscle. The right wrist and hand are destroyed. The left upper arm show loss of skin and subcutaneous tissue with exposure of underlying muscle and bone. The skin and subcutaneous tissues of the right upper back show exposure of underlying muscle. There is no soot present over the tongue, throughout the oropharynx, lining the trachea, mainstem bronchi or the distal bronchial branches. There is no soot present along the esophagus or within the stomach. DISPOSITION OF PERSONAL EFFECTS AND EVIDENCE The following items are released with the body CLOTHING: The deceased is clothed in charred red and green fabric. PERSONAL EFFECTS: One upper denture. The following items are preserved as evidence Page 2 of 6 F September :56

3 One DNA standard is routinely retained in the case file. PROCEDURES Radiographs Anterior-posterior full body radiographs are completed and reviewed. Identification The body is identified by circumstances and by bother's description of the absence of a right lower tooth. INTERNAL EXAMINATION Body Cavities The body is opened using a routine thoracoabdominal incision to reveal mature adipose tissue measuring 2.9 centimeters in thickness at the umbilicus. The anterior, dark-brown chest and abdominal muscles are without hemorrhage. The peritoneal cavity is free of fluid, hemorrhage or adhesions. After removal of the intact anterior chest plate, the right and left pleural cavities are free of fluid, hemorrhage or adhesions. The organs are in their normal anatomic locations. Cardiovascular System Heart Weight 285 grams From its external features, the heart is normal in size. The superior and inferior vena cavae and the coronary sinus connect normally to the enlarged right atrium. The right atrial appendage is enlarged without thrombi. The 12.5-centimeter tricuspid valve has normal, thin and delicate valve leaflets. The right ventricle is hypertrophic and dilated; the compact myocardium along the mid-posterior wall measures 0.3 centimeter in thickness. The myocardium is dark brown with no gross lesions identified. The right ventricular outflow tract leads to a normal, unobstructed, 5.5-centimeter pulmonary valve, a normal, unobstructed main pulmonary artery and normal, unobstructed pulmonary artery branches. The right and left pulmonary veins connect normally to the normal left atrium. The left atrial appendage is normal without thrombi. The 7.0-centimeter mitral valve has normal, thin and delicate valve leaflets. The left ventricle is normally formed; the compact myocardium along the mid-lateral wall measures 1.4 centimeters in thickness. The midventricular septum measures 1.0 centimeter in thickness. The myocardium is dark brown with no gross lesions identified. The left ventricular outflow tract leads to a normal, 4.5-centimeter aortic valve, a normal ascending thoracic aorta, a normal leftward aortic arch with three normal aortic arch arteries and normal descending thoracic aorta. The abdominal aorta is covered by moderate numbers of raised, calcified atherosclerotic plaques. The right subclavian artery is 90-95% narrowed by atherosclerotic plaque. The left common carotid artery is 90-98% narrowed by atherosclerotic plaque. The brachiocephalic artery is 50-75% narrowed by atherosclerotic plaque. The right renal artery is occluded. The left renal artery is 95-98% narrowed by atherosclerotic plaque. The ostia of the right and left coronary arteries arise normally from the right and left sinuses of Valsalva and give rise to coronary arteries with a right dominant distribution pattern. The right coronary artery is 95-98% narrowed by atherosclerotic plaque. The 90-95% narrowed anterior descending coronary artery gives rise to a 90-95% narrowed first diagonal coronary artery. The circumflex artery is occluded. Respiratory System Right Lung Weight 370 grams Left Lung Weight 100 grams The normally-formed epiglottis, vocal cords and proximal trachea are coated by blood. The normally-formed, unobstructed trachea and mainstem bronchi are lined by a tan mucosal packed with blood and connect normally to normally-formed lungs. Both lungs have shiny, anterior maroon pleural surfaces with prominent emphysematous changes in both upper lobes. The uniform, maroon, spongy parenchyma is without masses, nodules or cysts. The normally-formed distal bronchial branches are unobstructed. The unobstructed distal pulmonary artery branches are dilated and lined by intimal lipid plaques. Gastrointestinal System The tongue is normally formed without superficial or deep hemorrhage. The normally-formed, unobstructed esophagus Page 3 of 6 F September :56

4 is lined by a tan, linear mucosal surface and leads to a normally-formed, well-demarcated gastroesophageal junction without varices. The normally-formed stomach is lined by a tan mucosal surface over normal rugal folds and contains blood. The small bowel is intact with areas of focal charring. The appendix is not identified. The colon contains normal stool. Liver Liver Weight 1300 grams The uniform, firm, brown parenchyma is without masses, nodules or cysts. The normally-formed gallbladder is lined by a dark green, velvety mucosal surface and contains 1-2 milliliters of dark green, viscid bile and a single, lobulated, 2.0 x 1.5 x 1.0-centimeter, green gallstone. Extrahepatic bile ducts are patent. Spleen Spleen Weight 110 grams The cut surface shows prominent white pulp and two possible infarcts measuring up to 1.5 centimeters. Pancreas The pancreas is normal in size, shape and gross appearance. Urinary System Right Kidney Weight 40 grams Left Kidney Weight 70 grams Both capsules strip with difficulty to reveal red-brown, dull, granular cortical surfaces. The corticomedullary junction is blurred and the cortex is thinned. There is increased pelvic fat. The normally-formed bladder is lined by a tan-white mucosal surface. Reproductive System The normal vagina leads to a normal cervix. The small, triangular uterus has normal serosal, myometrial and endometrial layers. Both fallopian tubes and ovaries are normal in size, shape and gross appearance. Endocrine System The normally-formed, symmetric thyroid gland is dark brown, uniform and granular in gross appearance. The left adrenal gland shows cortical hyperplasia and a single, yellow cortical nodule measuring 2.0 x 1.0 x 0.5 centimeters. The pituitary gland is not identified. Neurologic System Brain Weight 450 grams Pertinent findings are described under "Injuries". Immunologic System The thymus is involuted. Lymph nodes throughout the body are normal in size, shape and gross appearance. Musculoskeletal System The hyoid bone and the thyroid and cricoid cartilages are intact without fracture or hemorrhage. The anterior, redbrown neck muscles are without hemorrhage. The pelvis is intact circumferentially without fracture or hemorrhage. The vertebral column has a normal architecture without dislocation, subluxation or spondylosis. MICROSCOPIC EXAMINATION Microscopic Comment Summary of sections: A. Brain The section shows heat-related artifact with large, empty spaces. Acute hemorrhage is present throughout the parenchyma. Page 4 of 6 F September :56

5 SUMMARY AND INTERPRETATION On March 28, 2017 at approximately 0217 hours, Aulander Fire/Rescue personnel were dispatched to the scene of a fire. Upon their arrival, the house was fully engulfed with no roof or walls remaining. Out-buildings were also burning. A burning propane tank was attended to first. Once it was extinguished, the remaining two rooms of the house were doused. Once the structure cooled, the remains of two people were found. A male victim (see B ) was found near the front door of the structure. A female victim (believed to be Luann Ambrose) was found in bed in a bedroom. A handgun was found near the male victim. According to reports, Ms. Ambrose had a history of chronic pain, hypertension, hyperlipidemia, tobacco use disorder and diabetes mellitus. Mr. Ambrose had been very stressed and depressed over their financial and pain situations. An autopsy was ordered to investigate her death. Significant autopsy findings included massive basilar skull fractures with cerebral contusions and lacerations and severe thermal injuries without soot along over the tongue, throughout the oropharynx, along the trachea and mainstem bronchi or distal bronchi. Additional findings included severe atherosclerotic coronary artery disease, severe atherosclerotic narrowing of both renal, left common carotid, right subclavian and brachiocephalic arteries, moderate aortic atherosclerosis, bilateral pulmonary emphysema, cholelithiasis, a cortical adrenal nodule and two splenic infarcts. The cause of death was deferred for additional studies. Histology of the brain showed acute hemorrhage in the cerebral parenchyma. Toxicology was negative for ethanol. Blood carbon monoxide saturation was < 5% (negative). The body was positively identified by comparison of absence of the right bottom tooth (according to brother). Given the investigative, autopsy and toxicological findings, it is my opinion that Ms. Luann Ambrose's cause of death was due to a gunshot wound of the head. DIAGRAMS 1. Body Diagram: Adult (Front/Back) Page 5 of 6 F September :56

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