Post-mortem computed tomography angiography using left ventricle cardiac puncture: A whole-body, angiographic approach

Abstract

Post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) are rapidly becoming effective and practical methods in forensic medicine. In this article, the authors introduce a whole-body PMCTA approach involving left ventricle cardiac puncture. This procedure was performed in 9 males and 3 females. PMCT was performed first. Then a biopsy core needle was used for a percutaneous puncture into the left ventricle through the intercostal area under CT guidance. 1000 mL of contrast media (diatrizoate meglumine and normal saline [0.9%] at 1:2 ratio) was injected at a rate of 50 mL/8 s, followed by CT scan. Visualization of systemic arteries was achieved in 11 cases, while only partial visualization was achieved in 1 case, which may have been related to incomplete thawing of the cadaver. PMCTA results revealed no vascular diseases and abnormalities in 10 victims. Among the 10 victims, 4 post-scan autopsies were performed and found no vascular abnormalities, consistent with the PMCTA results. Autopsy of the other 6 victims were refused by the relatives. PMCTA revealed signs of internal carotid artery aneurysm inside the sphenoid sinus in one victim, which was confirmed by autopsy. PMCTA results of another victim showed signs of stenosis and blockage of the distal part of the right vertebral artery and basilar artery. Thromboembolism of those arteries was found during autopsy. Compared with other existing PMCTA methods for examination of vascular injuries and diseases, this technique involves simple procedures, is less time consuming, has lower associated costs, does not require specialized equipment, provides adequate imaging quality, and is suitable for centres not equipped with cardiopulmonary bypass machines or other specialized equipment.

Diagnosis of Vascular Rupture Due to Arteriovenous Malformation Using Postmortem Angiography and 3-Dimensonal Printing

“…10 When the brain tissue is cut open, huge hematomas is seen surrounding the blood vessels, making it difficult for the naked eye to separate the malformed vessels. 11 The combination of PMCT and PMCTA allows a complex network of blood vessels to be visible and permanently preserved. This modality has been considered an alternative if an autopsy is refused.…”

“…Cerebral angiography can provide 3D pathoanatomical data about the cerebral vasculature, allowing for a real-time analysis of blood flow 10 . When the brain tissue is cut open, huge hematomas is seen surrounding the blood vessels, making it difficult for the naked eye to separate the malformed vessels 11 . The combination of PMCT and PMCTA allows a complex network of blood vessels to be visible and permanently preserved.…”

Virtopsy: A New Era in Forensic Medico-Legal Autopsies

“…Histological examination also established the facts of PMCT angiography that the death was caused by an arteriovenous distortion (Figure 4). In 2017, Shao et al [28] executed PMCT angiography on a deceased who suffered a head injury during a traffic accident. The deceases had fractures of frontal and sphenoid bones-left.…”

Rupture of the Ascending Aorta Surgical Area Detected Using Isolated Cardiopulmonary Organ Computed Tomography Angiography

“…We have previously identified traumatic aortic rupture, cerebral arteriovenous malformation, and coronary heart disease using PMCT and PMCTA and have developed a whole-body angiographic approach using left ventricular cardiac puncture 10–12 . In forensic pathology, we often encounter cases of death secondary to postsurgical complications.…”

“…[7][8][9] We have previously identified traumatic aortic rupture, cerebral arteriovenous malformation, and coronary heart disease using PMCT and PMCTA and have developed a whole-body angiographic approach using left ventricular cardiac puncture. [10][11][12] In forensic pathology, we often encounter cases of death secondary to postsurgical complications. Common complications after surgery include infections (eg, infections and adhesions in the surgical area), bleeding, and venous thrombosis of the lower extremities.…”