Virtual Autopsy With Multiphase Postmortem Computed Tomographic Angiography Versus Traditional Medical Autopsy to Investigate Unexpected Deaths of Hospitalized Patients

Wichmann, Dominic; Heinemann, Axel; Weinberg, Clarice R.; Vogel, H.; Hoepker, Wilhelm Wolfgang; Grabherr, Silke; Pueschel, Klaus; Kluge, Stefan

doi:10.7326/m13-2211

Cited by 60 publications

(48 citation statements)

References 30 publications

(31 reference statements)

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“…Consequently, various postmortem angiographic techniques have been developed (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Probably the most widespread single approach for postmortem angiography today is multiphase postmortem CT angiography (20)(21)(22)(23)(24)(25)(26)(27), first described in 2011 (14). This technique uses a standardized procedure on the basis of a defined injection and a scanning protocol that uses a specific perfusion device and an oil-based contrast agent of specific viscosity.…”

mentioning

confidence: 99%

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study

Grabherr¹,

Heinemann²,

Vogel³

et al. 2018

Radiology

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105

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Purpose: To determine if postmortem computed tomography (CT) and postmortem CT angiography help to detect more lesions than autopsy in postmortem examinations, to evaluate the strengths and weaknesses of each method, and to define their indications. Materials and Methods:Postmortem CT angiography was performed on 500 human corpses and followed by conventional autopsy. Nine centers were involved. All CT images were read by an experienced team including one forensic pathologist and one radiologist, blinded to the autopsy results. All findings were recorded for each method and categorized by anatomic structure (bone, organ parenchyma, soft tissue, and vascular) and relative importance in the forensic case (essential, useful, and unimportant).

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mentioning

confidence: 99%

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study

Grabherr¹,

Heinemann²,

Vogel³

et al. 2018

Radiology

Self Cite

105

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“…Therefore, traditional internal and external postmortem examination remains the gold standard, especially in hematologic and oncologic malignancies. 4 Identifying lymphomatous involvement of solid organs by radiographic imaging is especially problematic, as illustrated by cases 1, 5, and 6 presented in this article.…”

Section: Discussionmentioning

confidence: 95%

“…Virtual autopsy involves postmortem magnetic resonance imaging or CT in combination with software to create 3-dimensional images. 4 These radiographic techniques have been helpful in identifying bullet paths, bone fractures, and air or gas emboli. 5,6 However, the detection of pulmonary emboli, cardiovascular disease, and malignant tumors by imaging has its limitations.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Clinically Undiagnosed Hematopoietic Neoplasms Discovered at Autopsy

Podduturi

Guileyardo

Soto

et al. 2015

American Journal of Clinical Pathology

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These cases illustrate the importance of the traditional postmortem examination in not only confirming clinical diagnoses but also identifying previously unknown diagnoses. Hematologic malignancies may present with nonspecific clinical manifestations, and this series of cases also emphasizes the necessity for widening the differential diagnosis in patients with unexplained lactic acidosis and hepatic failure to include hematopoietic malignancies since prompt treatment may be lifesaving.

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“…In two UK centers in Manchester and Oxford, 182 unselected cases were assessed by radiology (CT and MRI) and autopsy for the cause of death [12]. In Aachen University Hospital, 29 cases were analyzed by CT and autopsy [13], and in the ICUs of Hamburg, 47 cases were analyzed by autopsy and PMI [14]. However, none of these reported cases similar to the ones presented here.…”

Section: Discussionmentioning

confidence: 98%

Newly recognized cerebral infarctions on postmortem imaging: a report of three cases with systemic infectious disease

et al. 2017

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BackgroundPostmortem imaging (PMI) refers to the imaging of cadavers by computed tomography (CT) and/or magnetic resonance imaging (MRI). Three cases of cerebral infarctions that were not found during life but were newly recognized on PMI and were associated with severe systemic infections are presented.Case presentationsAn 81-year-old woman with a pacemaker and slightly impaired liver function presented with fever. Imaging suggested interstitial pneumonia and an iliopsoas abscess, and blood tests showed liver dysfunction and disseminated intravascular coagulation (DIC). Despite three-agent combined therapy for tuberculosis, she died 32 days after hospitalization. PMI showed multiple fresh cerebral and cerebellar infarctions and diffuse ground-glass shadows in bilateral lungs. On autopsy, the diagnosis of miliary tuberculosis was made, and non-bacterial thrombotic endocarditis that involved the aortic valve may have caused the cerebral infarctions.A 74-year-old man on steroid therapy for systemic lupus erythematosus presented with severe anemia, melena with no obvious source, and DIC. Imaging suggested intestinal perforation. The patient was treated with antibiotics and drainage of ascites. However, he developed adult respiratory distress syndrome, worsening DIC, and renal dysfunction and died 2 months after admission. PMI showed infiltrative lung shadow, ascites, an abdominal aortic aneurysm, a wide infarction in the right parietal lobe, and multiple new cerebral infarctions. Autopsy examination showed purulent ascites, diffuse peritonitis, invasive bronchopulmonary aspergillosis, and non-bacterial thrombotic endocarditis that likely caused the cerebral infarctions.A 65-year-old man with an old pontine infarction presented with a fever and neutropenia. Despite appropriate treatment, his fever persisted. CT showed bilateral upper lobe pneumonia, pain appeared in both femoral regions, and intramuscular abscesses of both shoulders developed. His pneumonia worsened, his level of consciousness decreased, right hemiplegia developed, and he died. PMI showed a newly diagnosed cerebral infarction in the left parietal lobe. The autopsy revealed bilateral bronchopneumonia, right-sided pleuritis with effusion, an intramuscular abscess in the right thigh, and fresh multiple organ infarctions. Systemic fibrin thrombosis and DIC were also found. Postmortem cultures showed E. coli and Burkholderia cepacia.ConclusionCerebral infarction that is newly recognized on PMI might suggest the presence of severe systemic infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-016-0174-4) contains supplementary material, which is available to authorized users.

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Virtual Autopsy With Multiphase Postmortem Computed Tomographic Angiography Versus Traditional Medical Autopsy to Investigate Unexpected Deaths of Hospitalized Patients

Abstract: University Medical Center Hamburg-Eppendorf.

Cited by 60 publications

References 30 publications

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study

A Case Series of Clinically Undiagnosed Hematopoietic Neoplasms Discovered at Autopsy

Newly recognized cerebral infarctions on postmortem imaging: a report of three cases with systemic infectious disease

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