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Hepatic portal venous gas on postmortem CT scan
Hideki Asamura1, Makoto Ito, Kayoko Takayanagi
1Department of Legal Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan. asamura@sch.md.shinshu-u.ac.jp
Legal Medicine (Tokyo, Japan)
|August 2, 2005
Summary
Hepatic portal venous gas (HPVG) on postmortem CT scans can result from emergency airway management, not necessarily organic disease. This finding distinguishes it from typical clinical causes of HPVG.
Area of Science:
- Radiology
- Forensic Pathology
- Medical Imaging
Background:
- Hepatic portal venous gas (HPVG) is a rare finding often associated with serious intra-abdominal pathology.
- Computed tomography (CT) is a key imaging modality for detecting HPVG.
Observation:
- Two postmortem cases are presented: a 9-month-old infant (heat stroke) and a 28-year-old man (myocarditis).
- Both cases exhibited significant gastrointestinal distension with gas on CT scans.
- Autopsies revealed no organic causes for HPVG, such as bowel necrosis or obstruction.
Findings:
- The observed HPVG was attributed to gastrointestinal distension caused by emergency resuscitation techniques (bag-valve-masking or esophageal tracheal combitube).
- This mechanism differs from the established causes of clinical HPVG.
Implications:
- HPVG on postmortem CT scans may not always indicate lethal pathology.
- Awareness of resuscitation-induced HPVG is crucial for accurate interpretation of postmortem imaging.
- This finding can help prevent misdiagnosis of intra-abdominal disease in forensic investigations.