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Postmortem contrast-enhanced computed tomography via direct large-vessel puncture
Shogo Shimbashi1, Akiko Takeuchi2, Motoo Yoshimiya1
1University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
Insights
Postmortem contrast-enhanced CT (PMeCT) via direct large-vessel puncture is useful for identifying vascular lesions. This technique successfully diagnosed conditions like aortic dissection and aneurysm rupture in all cases.
Area of Science:
- Forensic Radiology
- Vascular Imaging
- Postmortem Imaging
Background:
- Routine postmortem CT may suggest vascular lesions but often lacks definitive detail.
- Identifying the precise source of vascular injury is crucial for determining cause of death.
- Postmortem imaging techniques require refinement for enhanced diagnostic accuracy.
Purpose of the Study:
- To evaluate the utility of postmortem contrast-enhanced CT (PMeCT) using direct large-vessel puncture.
- To assess PMeCT's effectiveness when initial postmortem CT indicates a vascular cause of death.
- To determine if PMeCT can accurately visualize and identify specific vascular pathologies.
Main Methods:
- PMeCT was performed in 9 cases following initial CT findings suggestive of vascular lesions.
- Target vessels were identified using CT data and a surface grid; an 18-G spinal needle was used for puncture.
- Contrast medium was injected incrementally with CT scans at each stage to monitor distribution and confirm no extravasation.
Main Results:
- PMeCT was successful in all 9 cases, with no procedure-related extravasation.
- Diagnoses included cardiac tamponade (n=7, including ascending aortic dissection and cardiac rupture), thoracic aortic aneurysm rupture (n=1), and iliac artery aneurysm rupture (n=1).
- The technique effectively visualized the extent and source of bleeding in vascular pathologies.
Conclusions:
- Postmortem contrast-enhanced CT via direct large-vessel puncture is a highly effective method for diagnosing vascular lesions.
- PMeCT provides definitive identification of bleeding sources when pericardial hematoma or cavity bleeding is suspected.
- This minimally invasive technique enhances the diagnostic capabilities of postmortem imaging for vascular deaths.
Abstract:
The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52-92) at the time of death. The mean time elapsed since death was 29.1 h (12.0-72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3-4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.
