Detection of aortic rupture using post-mortem computed tomography and post-mortem computed tomography angiography by cardiac puncture

Abstract

Post-mortem computed tomography (PMCT) and post-mortem computed tomography angiography (PMCTA) are rapidly becoming effective and practical methods in forensic medicine. In this article, we introduce a PMCTA approach by cardiac puncture and its application in a specific forensic case. A 50-year-old female sanitation worker was found dead on a road. External examination of the body revealed scattered abrasions and contusions over the chest. Autopsy was refused by the family members, and the body was examined with PMCT and PMCTA by cardiac puncture. Sternal fracture and rib fractures were detected by PMCT and aortic rupture by PMCTA. The cause of death was hemorrhagic shock due to traumatic aortic rupture. In certain circumstances, the combination of PMCT and PMCTA is helpful for forensic pathologists to determine the cause of death in cases involving traumatic vascular injury.

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

“…The combination of PMCT and PMCTA is time conserving and can provide three-dimensional images that enable clear visualization of deep and narrow blood vessels [ 5 , 11 , 13 , 14 ]. The combined approach has been applied, and has demonstrated its ability to detect vascular injuries and abnormities including cardiac and aortic injuries, intracranial arteriovenous malformation, and aneurysm [ 4 , 15 , 16 ]. This promising modality has been considered to be an effective supplement to autopsy or an alternative if autopsy is refused [ 11 , 17 ].…”

“…This study proposed a new approach to whole-body PMCTA―left ventricle cardiac puncture―which has high success rates and provides adequate visualization of arteries. Image quality is dependent on device performance, scanning parameters, body condition, and performance of device-dependent software and operator skill through digital postprocessing [ 4 ]. The PMCTA images obtained in this study were clear.…”

“…As described in detail previously [ 4 ], the entire body was scanned using a 40-slice multi-slice computed tomography system (MSCT; Definition AS, Siemens Medical Solutions, Munich, Germany). Raw data were acquired using the following settings: voltage, 120 kV; current, 240 mAs; collimation, 6.0×1.0 mm.…”

“…However, the accuracy of non-contrast enhanced PMCT for the diagnosis of vascular disease or trauma is low. PMCT angiography (PMCTA), however, enables better visualization of arteries than non-contrast-enhanced PMCT, and permits the evaluation of stenosis and occlusions [ 4 ]. It has been reported that the combination of PMCT and PMCTA is very helpful in diagnosing certain fatal injuries and vascular disease [ 5 – 7 ].…”

“…Worldwide, several forms of whole-body PMCTA have been described, including whole-body infusion angiographic techniques from Switzerland, and cardiopulmonary resuscitation to establish circulation in Japan [ 8 – 12 ]. In previous research, we reported a case in which aortic rupture was successfully detected by the combination of PMCT and PMCTA using cardiac puncture [ 4 ]. Here we introduce a whole-body PMCTA approach involving left ventricle cardiac puncture, which is simple, convenient, and effective for the visualization of arteries.…”