Coronary thrombus and peracute myocardial infarction visualized by unenhanced postmortem MRI prior to autopsy

Area of Science:

• Cardiovascular Pathology
• Forensic Medicine
• Medical Imaging

Background:

• Sudden cardiac death (SCD) is a significant cause of mortality.
• Macroscopic evidence of acute myocardial ischemia is frequently absent in SCD cases.
• Diagnosis often relies on coronary artery status and indirect signs of cardiac failure.

Observation:

• Cardiac postmortem magnetic resonance imaging (pmMRI) was utilized for pre-autopsy diagnosis.
• T2-weighted images showed hypointensities in the anterior basal ventricular septum, suggesting peracute ischemia.
• The left anterior descending artery (LAD) lumen displayed a homogeneous signal, indicating a lack of normal postmortem blood component sedimentation.

Findings:

• pmMRI revealed a narrowed LAD lumen with a homogeneous signal over 1cm, consistent with thrombotic occlusion.
• This finding suggested a peracute myocardial ischemia.
• Autopsy confirmed the pmMRI findings of LAD thrombotic occlusion and secondary septal ischemia.

Implications:

• Cardiac pmMRI can aid in the pre-autopsy diagnosis of SCD.
• This imaging modality offers valuable insights into acute ischemic events.
• pmMRI enhances the diagnostic accuracy in forensic pathology and clinical settings for sudden cardiac death.