Massive hemoperitoneum due to ruptured ectopic gestation: Postmortem CT findings in a deeply frozen deceased person

O’Donnell, Chris; Bedford, Paul; Burke, Michael P.

doi:10.1016/j.legalmed.2011.05.006

Cited by 20 publications

(8 citation statements)

References 25 publications

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“…Freezing the brain tissue may cause morphological changes, such as fractures, cellular shrinkage, and loss of staining. 40,41 These effects could influence the morphology of contrast enhancement in ICH. However, after somatic death, autolytic processes, which depend on the postmortem interval, influence the ultrastructure of brain tissue.…”

Section: Discussionmentioning

confidence: 99%

Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Won

Schlunk

Dinkel

et al. 2013

Stroke

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Background and Purpose Contrast medium extravasation (CE) in intracerebral hemorrhage (ICH) is a marker of ongoing bleeding and a predictor of hematoma expansion. The aims of the study were to establish an ICH model in which CE can be quantified, characterized in ICH during warfarin and dabigatran anticoagulation, and to evaluate effects of prothrombin complex concentrates on CE in warfarin-associated ICH. Methods CD 1-mice were pretreated orally with warfarin, dabigatran, or vehicle. Prothrombin complex concentrates were administered in a subgroup of warfarin-treated mice. ICH was induced by stereotactic injection of collagenase VIIs into the right striatum. Contrast agent (350 µL Isovue 370 mg/mL) was injected intravenously after ICH induction (2–3.5 hours). Thirty minutes later, mice were euthanized, and CE was measured by quantifying the iodine content in the hematoma using dual-energy computed tomography. Results The optimal time point for contrast injection was found to be 3 hours after ICH induction, allowing detection of both an increase and a decrease of CE using dual-energy computed tomography. CE was higher in the warfarin group compared with the controls (P=0.002). There was no significant difference in CE between dabigatran-treated mice and controls. CE was higher in the sham-treated warfarin group than in the prothrombin complex concentrates–treated warfarin group (P<0.001). Conclusions Dual-energy computed tomography allows quantifying CE, as a marker of ongoing bleeding, in a model of anticoagulation-associated ICH. Dabigatran induces less CE in ICH than warfarin and consequently reduces risks of hematoma expansion. This constitutes a potential safety advantage of dabigatran over warfarin. Nevertheless, in case of warfarin anticoagulation, prothrombin complex concentrates reduce this side effect.

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Section: Discussionmentioning

confidence: 99%

Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Won

Schlunk

Dinkel

et al. 2013

Stroke

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“…Complicated endometriosis and spontaneous uterine rupture are more rarely reported. Ruptured splenic artery aneurysm and spontaneous spleen ruptures are exceptionally described (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Ruptured ectopic pregnancies may be responsible for life‐threatening and even fatal hemorrhages. Postmortem examinations in these cases usually reveal massive hemoperitoneum . Hemorrhagic ruptures at the ectopic pregnancy site and the presence of a gestational sac may be macroscopically identified.…”

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confidence: 99%

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Determination of Human Chorionic Gonadotropin in Postmortem Samples in Ectopic Pregnancies

Palmière

Lesta

Fanton

et al. 2015

Journal of Forensic Sciences

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Increased human chorionic gonadotropin levels (HCG) can be detected in femoral blood, bile, and vitreous humor collected during autopsy of pregnant women using a standard kit designed for living patients. In the study herein, the concentrations of HCG were measured in postmortem serum, vitreous, bile, cerebrospinal, and pericardial fluids in 4 cases of fatal ectopic pregnancy and 40 controls using a quantitative electrochemiluminescence immunoassay designed for living patients. No false-negative cases were identified in any of the analyzed samples in any of the ectopic pregnancy cases. No correlations were found between total HCG levels in postmortem serum and the other tested specimens. The results of this study would suggest that higher HCG in bile, vitreous, pericardial, and cerebrospinal fluids may confirm the existence of ectopic pregnancy and therefore identify other situations in which this hormone is increased, although gestational age cannot be reliably estimated using these values.

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“…Few studies have analyzed, both microscopically and radiographically, the effects of freezing temperatures on human organ integrity, specifically in adult cardiac, hepatic, brain, and bone tissue [4][5][6][7]. Other forensically oriented studies have focused on the histopathological evaluation of newborn tissue after freeze-thaw events [3,8].…”

Section: Discussionmentioning

confidence: 99%

Feasibility, diagnostic validity and limits of postmortem evaluation of a newborn infant following an extremely prolonged freezing interval: A thanatological case study

et al. 2014

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Massive hemoperitoneum due to ruptured ectopic gestation: Postmortem CT findings in a deeply frozen deceased person

Cited by 20 publications

References 25 publications

Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Determination of Human Chorionic Gonadotropin in Postmortem Samples in Ectopic Pregnancies

Feasibility, diagnostic validity and limits of postmortem evaluation of a newborn infant following an extremely prolonged freezing interval: A thanatological case study

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