Abstract
Objectives
When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT.
Materials and methods
We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding.
Results
Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases).
Conclusions
PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.
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References
Saukko P, Knight B (1996) Chest and abdominal injuries. In: Saukko P, Knight B (eds) Forensic pathology. Arnold, London, p 228
Eisenmenger W (2004) Spitze, scharfe und halbscharfe Gewalt. In: Brinkmann B, Madea B (eds) Handbuch Gerichtliche Medizin, vol 1. Springer, Berlin, p 576
Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD (2013) American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 26:965–1012
Wann S, Passen E (2007) Echocardiography in pericardial disease. J Am Soc Echocardiogr 21:7–13
Oyama N, Oyama N, Komuro K, Nambu T, Manning WJ, Miyasaka K (2004) Computed tomography and magnetic resonance imaging of the pericardium: anatomy and pathology. Magn Reson Med Sci 3:145–152
Killeen KL, Poletti PA, Shanmuganathan K, Mirvis SE (1999) CT diagnosis of cardiac and pericardial injuries. Emerg Radiol 6:339–344
Krejci CS, Blackmore CC, Nathens A (2000) Hemopericardium: an emergent finding in a case of blunt cardiac injury. AJR Am J Roentgenol 175:250
Harries SR, Fox BM, Roobottom CA (1998) Azygos reflux: a CT sign of cardiac tamponade. Clin Radiol 53:702–704
Rotondo A, Scialpi M, Catalano O, Strada A, Grassi R, Angelelli G (1999) Periportal lymphatic distension resulting from cardiac tamponade: CT findings and clinical-pathologic correlation. Emerg Radiol 6:85–93
Hernandez-Luyando L, Calvo J, de las Gonzalez Heras E, de la Puente H, Lopez C (1996) Tension pericardial collections: sign of “flattened heart” in CT. Eur J Radiol 23:250–252
Steiner MA, Marshall JJ (2000) Coronary sinus compression as a sign of cardiac tamponade. Catheter Cardiovasc Interv 49:455–458
Doppman JL, Rienmuller R, Lissner J et al (1981) Computed tomography in constrictive pericardial disease. J Comput Assist Tomogr 5:1–11
Frantz KM, Fishman EK (1992) Hemopericardium leading to cardiac tamponade in the traumatized pediatric patient: discovery by CT. Clin Imaging 16:180–182
Chong HH, Plotnick GD (1995) Pericardial effusion and tamponade: evaluation, imaging modalities, and management. Compr Ther 21:378–385
Restrepo CS, Lemos DF, Lemos JA, Velasquez E, Diethelm L, Ovella TA, Martinez S, Carrillo J, Moncada R, Klein JS (2007) Radiographics 27:1595–1610
Karger B, Niemeyer J, Brinkmann B (1999) Physical activity following fatal injury from sharp pointed weapons. Int J Legal Med 112:188–191
Moritz AR (1942) The pathology of trauma. Lea & Febiger, Philadelphia
Huang P, Wan L, Qin Z, Zhang J, Liu N, Zou D, Chen Y (2012) Post-mortem MSCT diagnosis of acute pericardial tamponade caused by blunt trauma to the chest in a motor-vehicle collision. Rom J Leg Med 20:117–122
Filograna L, Hatch G, Ruder T, Ross SG, Bolliger SA, Thali MJ (2013) The role of post-mortem imaging in a case of sudden death due to ascending aorta aneurysm rupture. Forensic Sci Int 228:e76–e80
Shiotani S, Watanabe K, Kohno M, Ohashi N, Yamazaki K, Nakayama H (2004) Postmortem computed tomographic (PMCT) findings of pericardial effusion due to acute aortic dissection. Radiat Med 22:405–407
Ebert LC, Ampanozi G, Ruder TD, Hatch G, Thali MJ, Germerott T (2012) CT based volume measurement and estimation in cases of pericardial effusion. J Forensic Leg Med 19:126–131
Ebert LC, Schön CA, Ruder TD, Thali MJ, Hatch GM (2012) Fatal left ventricular rupture and pericardial tamponade following a horse kick to the chest. Am J Forensic Med Pathol 33:167–169
Filograna L, Flach PM, Bolliger SA, Thali MJ (2014) The role of post-mortem CT (PMCT) imaging in the diagnosis of pericardial tamponade due to hemopericardium: a case report. Leg Med 16:150–153
Filograna L, Thali MJ, Marchetti D (2014) Forensic relevance of post-mortem CT imaging of the hemopericardium in determining the cause of death. Leg Med 16:247–251
Ishikawa N, Nishida A, Miyamori D, Kubo T, Ikegaya H (2013) Estimation of postmortem time based on aorta narrowing in CT imaging. J Forensic Leg Med 2010:75–77
Rutty GN, Morgan B, O’Donnell C, Leth PM, Thali M (2008) Forensic institutes across the world place CT or MR scanners or both into their mortuaries. J Trauma 63:493–494
Tartaglione T, Filograna L, Roiati S, Guglielmi G, Colosimo C, Bonomo L (2012) Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds. Radiol med 117:461–470
Ambrosetti MC, Barbiani C, El-Dalati G, Pellini E, Raniero D, De Salvia A, Pozzi Mucelli R (2013) Virtual autopsy using multislice computed tomography in forensic medical diagnosis of drowning. Radiol Med 118:679–687
Jackowski C, Thali M, Aghayev E, Yen K, Sonnenschein M, Zwygart K, Dirnhofer R, Vock P (2006) Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med 120:233–240
Shiotani S, Kohno M, Ohashi N, Yamazaki K, Nakayama H, Watanabe K, Itai Y (2003) Dilatation of the heart on postmortem computed tomography (PMCT): comparison with live CT. Radiat Med 21:29–35
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Filograna, L., Laberke, P., Ampanozi, G. et al. Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium. Radiol med 120, 723–730 (2015). https://doi.org/10.1007/s11547-015-0517-1
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DOI: https://doi.org/10.1007/s11547-015-0517-1