Imaging changes of pulmonary thromboembolism on postmortem computed tomography.

Area of Science:

• Forensic Radiology
• Postmortem Imaging
• Radiology

Background:

• Postmortem CT (PMCT) findings vary with postmortem interval (PMI), complicating pulmonary thromboembolism (PTE) assessment.
• Postmortem evolution of thrombus imaging characteristics is insufficiently understood.

Purpose of the Study:

• To report the time-dependent imaging evolution of pulmonary thromboemboli using serial non-contrast PMCT.
• To highlight the diagnostic utility of recognizing temporal imaging alterations in PTE.

Main Methods:

• Serial non-contrast PMCT performed at 1 hour and 96 hours postmortem on a PTE case.
• Measurement of thrombus and vascular lumen attenuation in Hounsfield units (HU).
• Calculation of contrast ratio between thrombus and lumen.

Main Results:

• Initial thrombus attenuation: 45 HU; lumen: 58 HU. Delayed thrombus attenuation: 70 HU; lumen: 30 HU.
• Contrast ratio increased from 13% to 40%, enhancing thrombus conspicuity.
• Autopsy confirmed bilateral pulmonary artery thromboemboli.

Conclusions:

• Progressive enhancement in thrombus conspicuity reflects postmortem processes like plasma separation and hypostasis.
• Relative attenuation differences offer reliable diagnostic information despite CT parameter variability.
• Findings may guide development of time-sensitive postmortem imaging protocols.