Immediate non-traumatic postmortem computed tomographic demonstration of myocardial intravascular gas of the left ventricle: effects from cardiopulmonary resuscitation

Okuda, Takahisa; Shiotani, Seiji; Kobayashi, Tomoya; Kohno, Mototsugu; Hayakawa, Hideyuki; Kikuchi, Kazunori; Suwa, Kunio

doi:10.1186/2193-1801-2-86

Cited by 14 publications

(4 citation statements)

References 31 publications

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“…[ 12 , 27 , 53 , 54 ] Intravascular air after resuscitation is caused by pneumatization of dissolved gas in the blood as a result of compression and expansion of vessels and direct mechanical force to the chest allowing air from the lungs to enter the bloodstream. [ 55 , 56 ] Likewise resuscitation attempts may introduce free abdominal air that should not be confused with free air caused by intestinal perforation. [ 13 ] Pleural effusion, periportal edema, and distended intestines were also more frequently observed after resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Total-body CT and MR features of postmortem change in in-hospital deaths

Wagensveld

Blokker

Wielopolski³

et al. 2017

PLoS ONE

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ObjectivesTo evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths.Materials and methodsIn this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance.ResultsIntravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026).ConclusionsThere is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.

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Section: Discussionmentioning

confidence: 99%

Total-body CT and MR features of postmortem change in in-hospital deaths

Wagensveld

Blokker

Wielopolski³

et al. 2017

PLoS ONE

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“…It is proposed that the origin of such gas occurring within the vascular tree is the result of the inflow of air secondary to medical venous cannulation and catheterization, pneumatization of dissolved gas within the blood as a result of cardiac massage (chest compressions), pulmonary parenchymal injury as a result of cardiopulmonary resuscitation or a combination of these mechanisms. [16][17][18][19][20] During cardiopulmonary resuscitation, the gas which has reached the described venous structures ascends or descends in a retrograde fashion (for example, to the brain or liver). On post-mortem imaging assessment, because cardiopulmonary resuscitation has not been successful and antegrade venous flow has not been reinstated, the intravascular gas is not carried away from these veins.…”

Section: Cardiovascular and Abdominal Visceral Intravascular Gasmentioning

confidence: 99%

Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Offiah¹,

Dean²

2016

BJR

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Post-mortem cross-sectional imaging in the form of CT and, less frequently, MRI is an emerging facility in the evaluation of cause-of-death and human identification for the coronial service as well as in assisting the forensic investigation of suspicious deaths and homicide. There are marked differences between the radiological evaluation and interpretation of the CT and MRI features of the live patient (i.e. antemortem imaging) and the evaluation and interpretation of postmortem CT and MRI appearances. In addition to the absence of frequently utilized tissue enhancement following intravenous contrast administration in antemortem imaging, there are a number of variable changes which occur in the tissues and organs of the body as a normal process following death, some of which are, in addition, affected significantly by environmental factors. Many patients and victims will also have undergone aggressive attempts at cardiopulmonary resuscitation in the perimortem period which will also significantly alter post-mortem CT and MRI appearances. It is paramount that the radiologist and pathologist engaged in the interpretation of such post-mortem imaging are familiar with the appropriate non-pathological imaging changes germane to death, the post-mortem interval and cardiopulmonary resuscitation in order to avoid erroneously attributing such changes to trauma or pathology. Some of the more frequently encountered radiological imaging considerations of this nature will be reviewed. INTRODUCTIONPost-mortem cross-sectional imaging assessment in the form of CT and, less frequently, MRI has become an emerging phenomenon in the UK to assist the coronial service in identifying the cause of death non-invasively in individuals where circumstances are non-suspicious or nonhomicidal but where appropriate recent medical history is not available. Such imaging has also become a versatile addition to the armoury available to the forensic pathologist and crime scene investigating (police) authorities in the evaluation of suspicious and homicidal causes of death.

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“…We noticed that epicardial adipose tissue heterogeneities were only visible if there was an increased quantity of epicardial fat above the myocardial wall rupture site. Furthermore, we could verify that the gas accumulations in the myocardium or the epicardial adipose tissue should not be interpreted as heterogeneities of the tissues and are not a sign of myocardial wall rupture, but rather resuscitation related changes [26].…”

Section: Discussionmentioning

confidence: 98%

Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography

Ampanozi

Flach

Ruder

et al. 2017

Forensic Sci Med Pathol

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The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as "aortic dissection", "myocardial wall rupture" or "undetermined". Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.

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Immediate non-traumatic postmortem computed tomographic demonstration of myocardial intravascular gas of the left ventricle: effects from cardiopulmonary resuscitation

Cited by 14 publications

References 31 publications

Total-body CT and MR features of postmortem change in in-hospital deaths

Total-body CT and MR features of postmortem change in in-hospital deaths

Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography

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