Investigation of medical intervention with fatal outcome: the impact of post-mortem CT and CT angiography

Abstract

Post-mortem computed tomography (PMCT) has been proven for its appropriateness to become an integral part of routine pre-autoptic forensic investigations either in the field of forensic investigation of fatal medical error or in hospital quality management. The autoptic investigation of unexpected and peri-interventional deaths can be usefully guided by post-mortem imaging which offers significant added value in the documentation of misplacement of medical devices before dissection with the risk of artificial relocation and the detection of iatrogenic air embolism. Post-mortem CT angiography (PMCTA) augments PMCT in the search for sources of hemorrhages and for the documentation of vascular patency and unimpaired perfusion after general and cardiovascular surgery or transvascular catheter-assisted interventions. Limitations of PMCT and PMCTA in medical error cases are method-related or time-dependent including artifacts by early post-mortem tissue change. Thromboembolic complications including pulmonary embolism, the differentiation of ante- and post-mortem coagulation and the detection of myocardial infarction remain areas with compromised diagnostic efficiency as compared to autopsy. Furthermore, extended survival periods after a complication in question impedes visualization of contrast agent extravasation at vascular leakage sites. PMCT and PMCTA contribute substantially for proving a correct interventional approach and guide forensic or clinical autopsy in the reconstruction of adverse medical events with fatal outcome. Post-mortem imaging could also assume a new role as an alternative in a clinicopathological setting if autopsy is not achievable when the probability in the individual case is acceptable to answer specific questions.

Postmortem imaging as a complementary tool for the investigation of cardiac death

“…PMA allows visualization of the bypass to control its permeability. The advantages of PMCT include exact localization of surgical clips that typically accompany the manipulated vessel [79].…”

Fatal Road Traffic Vehicle Collisions With Pedestrian Victims

“…On the contrary, subtle fracture hematomas are usually not depicted by PMCT. 27 According to Heinemann et al 37 and Schmitt-Sody et al, 27 PMCT can also give valid answers to medicolegal questions concerning the precise location of any installed endotracheal intubation tubes or drainages in bodily cavities and aspects of osteosynthetic material placement. Such issues concern all of the handled medical cases during a forensic investigation, and it is of primary importance to also better investigate claims or suspicions of medical malpractice.…”

Perkütan nefrolitotomi operasyonunun nadir ama ölümcül bir komplikasyonu; masif hava embolisi.

“…Adli tıp uygulamaları arasında sebebi bilinmeyen ölümlerin aydınlatılması konusunda hava embolisi tanının en zor konulduğu olgulardan birisidir [1]. Bu şüphenin olduğu durumlarda detaylı bir otopsi yanında iyi bir olgu öyküsü ve önceki klinik bilgilerini değerlendirmek tanıda referans nokta olabilir [1].…”

“…Adli tıp uygulamaları arasında sebebi bilinmeyen ölümlerin aydınlatılması konusunda hava embolisi tanının en zor konulduğu olgulardan birisidir [1]. Bu şüphenin olduğu durumlarda detaylı bir otopsi yanında iyi bir olgu öyküsü ve önceki klinik bilgilerini değerlendirmek tanıda referans nokta olabilir [1]. Hava embolisi çok nadir görülen bir komplikasyon olması yanında tanı için şüphe duyulması gereken ve sonuçları açısından ise hızlı tedavisinin sağlanması ve gerekli önlemlerin her zaman alınması gereken olgulardır [2][3].…”