Diagnosis of cardiac rupture using PMeCT by direct large-vessel puncture and CT-guided biopsy: A case report

We report a case of a minimally invasive autopsy using postmortem contrast-enhanced computed tomography (PMeCT) by direct large-vessel puncture combined with CT-guided myocardial biopsy as a novel method to determine the cause of death. The case involved a man in his 60 s who was found dead at his residence. Postmortem CT revealed a hematoma around the heart, suggesting the possibility of a post-myocardial infarction cardiac rupture or aortic dissection. PMeCT revealed contrast agent infiltration into the myocardium and leakage into the pericardium, indicating pericardial hematoma, likely due to cardiac rupture. A CT-guided percutaneous biopsy was performed on the area of contrast infiltration, and subacute myocardial infarction was observed 3-7 days after onset. Postmortem CT angiography provides detailed vascular images and is a valuable tool for evaluating pericardial hematomas and cardiac ruptures; however, the cost of the equipment and time constraints have limited its widespread use. To address these challenges, a relatively inexpensive technique called PMeCT by direct large-vessel puncture has been developed. To our knowledge, this is the first practical demonstration of combining PMeCT by direct large-vessel puncture with CT-guided myocardial biopsy in an actual forensic death investigation. This case illustrates how this minimally invasive approach can yield both radiological and histopathological insights, potentially offering a viable alternative in cases where a conventional autopsy is not feasible. As a supplementary report to our previous technical study, this case highlights the real-world applicability and diagnostic value of the technique, especially for identifying cardiac rupture.