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Can post-mortem computed tomography be considered an alternative for autopsy in deaths due to hemopericardium?
Lorenzo Gitto1, Serenella Serinelli1, Francesco P Busardò1
1Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy.
Insights
Post-mortem computed tomography (PMCT) accurately identified hemopericardium and aortic dissection as the cause of death in a deceased individual. This imaging technique shows promise for determining cause of death, potentially reducing the need for traditional autopsies in select cases.
Area of Science:
- Forensic pathology
- Radiology
- Cardiovascular imaging
Background:
- Hemopericardium is a common autopsy finding but determining its role in death can be challenging.
- Post-mortem computed tomography (PMCT) is an emerging technique for evaluating acute hemopericardium with reported accuracy.
- Few studies have explored PMCT's utility in post-mortem investigations of hemopericardium.
Observation:
- A 70-year-old male with a history of hepatitis C and hypertension was found deceased.
- A PMCT scan performed 3 hours post-discovery revealed intrapericardial aortic dissection with associated hematomas and hemopericardium.
- The PMCT identified a false lumen and intramural hematoma, indicative of aortic dissection.
Findings:
- PMCT successfully identified an intrapericardial aortic dissection leading to hemopericardium as the cause of death.
- Radiological findings were confirmed by a subsequent traditional autopsy.
- The study highlights the accuracy of PMCT in diagnosing acute hemopericardium and associated pathologies.
Implications:
- PMCT is a reliable tool for forensic pathologists investigating deaths involving hemopericardium.
- In specific cases, PMCT may provide sufficient evidence to determine the cause of death, potentially negating the need for a traditional autopsy.
- This imaging modality enhances the diagnostic capabilities in post-mortem examinations of cardiovascular emergencies.
Abstract:
Hemopericardium is a common finding at autopsy, but it may represent a challenge for the forensic pathologist when the etiopathological relationship in causing death is requested. Hemopericardium and cardiac tamponade can be evaluated in living people using radiological techniques, in particular computer tomography (CT). Only a few studies are reported in literature involving post-mortem (PM) cases, where PMCT imaging has been used in order to investigate acute hemopericardium, and they have shown a good accuracy of this technique. Here we report a case involving a 70-year-old white male found dead on the beach, with a medical history of hepatitis C and chronic hypertension with a poor pharmacological response. A PMCT was performed about 3 h after the discovery of the body. The PMCT examination showed an intrapericardial aortic dissection associated to a periaortic hematoma, a sickle-shaped intramural hematoma, a false lumen, and a hemopericardium consisting in fluid and clotted blood. In this case, the PMCT was able to identify the cause of death, even though a traditional autopsy was required to confirm the radiological findings. PMCT is a reliable technique, which in chosen cases, can be performed without the need for a traditional autopsy to be carried out.
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