Postmortem CT and MRI findings of massive fat embolism

Makino, Yohsuke; Kojima, Masatoshi; Yoshida, Maiko; Motomura, Ayumi; Inokuchi, Go; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Yamaguchi, Ryuhei; Saito, Naoki; Urabe, Shumari; Tsuneya, Shigeki; Horikoshi, Takuro; Yajima, Daisuke; Iwase, Hirotaro

doi:10.1007/s00414-019-02128-8

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…Fifty five percent of the result shows true positive and 93% of the result shows true negative in high Falzi grade. 9 As stated earlier, PMCT conducted by Makino et al 10 revealed fat densities that were clearly evident floating in the blood in the right ventricle or pulmonary trunk, displaying a "fat-fluid level" in one of the cases, while one of the other cases also showed fat around the ventricle wall without apparent "fat-fluid level". PMCT also showed fat densities in the pulmonary arteries in two of the cases, although one of them was unclear.…”

Section: Discussionmentioning

confidence: 69%

“…Four studies evaluating PMCT are Filograna et al 3 ; Flach et al 7 ; Chatzaraki et al 9 We also found four studies evaluating biopsy technique, which were conducted by Filograna et al 3 ; Flach et al 7 ; Makino et al 10 respectively. In addition, there is one study evaluating PMMR, which was conducted by Makino et al 10 We summarize the included studies by the outcome and conclusion as shown in Table 3.…”

Section: Lung Findingsmentioning

confidence: 99%

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Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis

Yen

Valentina

Hamid

et al. 2021

mkb

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In recent years, imaging technologies and minimally invasive biopsy have been gaining importance in forensic settings. This study aimed to evaluate the role of imaging and minimally invasive biopsy in postmortem diagnosis of pulmonary fat embolism. This was a systematic literature review by using Pubmed, EBSCO-Host, and ProQuest to search for studies on postmortem diagnosis of pulmonary fat embolism with postmortem imaging and minimally invasive biopsy. Five studies were included in the systematic review. These studies employed the following diagnostic technics: postmortem computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), percutaneous needle biopsy (PNB), postmortem magnetic resonance (PMMR), and traditional autopsy. Imaging and minimally invasive biopsy are potential modalities that might complement or even replace traditional autopsy in diagnosing PFE. Further studies are needed to confirm the sensitivity and specificity of each technique.

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Section: Discussionmentioning

confidence: 69%

Section: Lung Findingsmentioning

confidence: 99%

Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis

Yen

Valentina

Hamid

et al. 2021

mkb

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show abstract

“…There have been recent publications discussing the postmortem computed tomography (PMCT) and magnetic resonance imaging findings in fat embolism compared with microscopy. Makino and colleagues stated that massive pulmonary fat embolism can be suggested by a “fat-fluid level” in the right ventricle or pulmonary trunk or fat in the pulmonary artery branches (53). Chatzaraki and colleagues examined 366 cases of pulmonary fat embolism cases and compared them with controls.…”

Section: Discussionmentioning

confidence: 99%

“…or pulmonary trunk or fat in the pulmonary artery branches (53). Chatzaraki and colleagues examined 366 cases of pulmonary fat embolism cases and compared them with controls.…”

Section: Review Articlementioning

confidence: 99%

Fat Embolism, Fat Embolism Syndrome and the Autopsy

Milroy¹,

Parai²

2019

Academic Forensic Pathology

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Fat embolism is common following trauma and is a common autopsy finding in these cases. It may also be seen in non-traumatic cases and is seen in children as well as adults. In comparison fat embolism syndrome (FES) only occurs in a small number of trauma and non-trauma cases. Clinical diagnosis is based on characteristic clinical and laboratory findings. Fat embolism exerts its effect by mechanical blockage of vessels and/or by biochemical means including breakdown of fat to free fatty acids causing an inflammatory response. Fat embolism can be identified at autopsy on microscopy of the lungs using fat stains conducted on frozen tissue, including on formalin fixed but not processed tissue. With FES fat emboli can be seen in other organs including the brain, kidney and myocardium. Fat can also be identified with post-fixation staining, typically with osmium tetroxide. Scoring systems have been developed to try and determine the severity of fat embolism in lung tissue. Fat embolism is also common following resuscitation. When no resuscitation has taken place, the presence of fat on lung histology has been used as proof of vitality. Diagnosis of fat embolism syndrome at autopsy requires analysis of the history, clinical and laboratory findings along with autopsy investigations to determine its relevance, but is an important diagnosis to make which is not always identified clinically. This paper reviews the history, clinical and laboratory findings and diagnosis of fat embolism and fat embolism syndrome at autopsy.

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“…This is more easily detectable in PMMR than in PMCT. 40 The use of MPMCTA is limited as the oily contrast agent mixture mimics FE. 12 In such cases, preangiography pulmonary biopsies are suggested or the change of the applied contrast agent.…”

Section: The Diagnostic Approachmentioning

confidence: 99%

The Lausanne forensic pathology approach to post-mortem imaging for natural and non-natural deaths

Magnin¹,

Grabherr²,

Michaud³

2020

Diagnostic Histopathology

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Post-mortem imaging by computed tomography (PMCT) and postmortem CT angiography (PMCTA) are used routinely in forensic practice as components to the autopsy. PMCT is efficient for gas detection, foreign body visualization and skeleton analysis. Various parameters can lead to the indication for contrast agent injection. Contrast injection into the vascular system can overcome the disadvantages of non-contrast PMCT by visualization of solid organ parenchyma and vessels. This can also assist the conventional autopsy, allowing one to investigate the vascular system. It is the method of choice for the analysis of the blood vessels by showing vascular pathology, congenital or postsurgical anatomical variations and an exact source of bleeding. By knowing the artefacts linked to the angiographic technique, we limit the risk of misinterpretation. The use of post-mortem MRI (PMMR) for diagnostic purposes is still limited to rare indications. These include review of the neck in cases of death by mechanical asphyxia, total-body PMMR in neonatal and pediatric death and cardiac PMMR in case of suspected myocardial infraction. Currently, in our daily practice, the vast majority or PMMR is only performed for research purposes.

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Postmortem CT and MRI findings of massive fat embolism

Cited by 12 publications

References 41 publications

Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis

Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis

Fat Embolism, Fat Embolism Syndrome and the Autopsy

The Lausanne forensic pathology approach to post-mortem imaging for natural and non-natural deaths

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