Postmortem contrast-enhanced computed tomography via direct large-vessel puncture

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.