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Pitfalls in post-mortem CT-angiography - intravascular contrast induces post-mortem pericardial effusion


Berger, Nicole; Martinez, Rosita; Winklhofer, Sebastian; Flach, Patricia M; Ross, Steffen; Ampanozi, Garyfalia; Gascho, Dominic; Thali, Michael J; Ruder, Thomas D (2013). Pitfalls in post-mortem CT-angiography - intravascular contrast induces post-mortem pericardial effusion. Legal medicine (Tokyo, Japan), 15(6):315-317.

Abstract

We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.

Abstract

We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Institute of Legal Medicine
Dewey Decimal Classification:340 Law
610 Medicine & health
Language:English
Date:2013
Deposited On:19 Sep 2013 08:25
Last Modified:05 Apr 2016 16:59
Publisher:Elsevier
ISSN:1344-6223
Publisher DOI:https://doi.org/10.1016/j.legalmed.2013.07.001
PubMed ID:23916606

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