Journal Article

Detection of hemorrhage source: The diagnostic value of post-mortem CT-angiography

Chevallier, C., Mangin, P., Doenz, F., Palmiere, C., Binaghi, S., Bize, P., Grabherr, S.

2012

Overview

The aim of this study was to compare the diagnostic value of post-mortem computed tomography angiography (PMCTA) to conventional, ante-mortem computed tomography (CT)-scan, CT-angiography (CTA) and digital subtraction angiography (DSA) in the detection and localization of the source of bleeding in cases of acute hemorrhage with fatal outcomes. The medical records and imaging scans of nine individuals who underwent a conventional, ante-mortem CT-scan, CTA or DSA and later died in the hospital as a result of an acute hemorrhage were reviewed. Post-mortem computed tomography angiography, using multi-phase post-mortem CTA, as well as medico-legal autopsies were performed. Localization accuracy of the bleeding was assessed by comparing the diagnostic findings of the different techniques. The results revealed that data from ante-mortem and post-mortem radiological examinations were similar, though the PMCTA showed a higher sensitivity for detecting the hemorrhage source than did ante-mortem radiological investigations. By comparing the results of PMCTA and conventional autopsy, much higher sensitivity was noted in PMCTA in identifying the source of the bleeding. In fact, the vessels involved were identified in eight out of nine cases using PMCTA and only in three cases through conventional autopsy. Our study showed that PMCTA, similar to clinical radiological investigations, is able to precisely identify lesions of arterial and/or venous vessels and thus determine the source of bleeding in cases of acute hemorrhages with fatal outcomes.

• Publisher: Elsevier Ireland Ltd,Elsevier,Elsevier Limited
• Subject: Adolescent / Aged / Aged, 80 and over / Angiography / Angiography, Digital Subtraction / Autopsies / Autopsy / Biological and medical sciences / Bleeding / Cardiovascular system / Computation / Diagnostic systems / Female / Forensic medicine / Forensic Pathology / Forensic sciences / General aspects / Hemorrhage / Hemorrhage - etiology / Hemorrhages / Hepatic Artery - diagnostic imaging / Hepatic Artery - injuries / Hepatic Artery - pathology / Humans / Iliac Artery - diagnostic imaging / Iliac Artery - injuries / Iliac Artery - pathology / Iliac Vein - diagnostic imaging / Iliac Vein - injuries / Iliac Vein - pathology / Intracranial Arteriovenous Malformations - diagnosis / Investigative techniques, diagnostic techniques (general aspects) / Male / Medical sciences / Mesenteric Artery, Superior - diagnostic imaging / Mesenteric Artery, Superior - injuries / Mesenteric Artery, Superior - pathology / Middle Aged / Middle Cerebral Artery - diagnostic imaging / Middle Cerebral Artery - injuries / Middle Cerebral Artery - pathology / Pathology / Pelvis - blood supply / Position (location) / Post-mortem angiography / Public health. Hygiene / Public health. Hygiene-occupational medicine / Radiodiagnosis. Nmr imagery. Nmr spectrometry / Renal Veins - diagnostic imaging / Renal Veins - injuries / Renal Veins - pathology / Retrospective Studies / Spleen - diagnostic imaging / Spleen - injuries / Spleen - pathology / Superior Sagittal Sinus - diagnostic imaging / Superior Sagittal Sinus - injuries / Superior Sagittal Sinus - pathology / Tomography / Tomography, X-Ray Computed / Young Adult