Forensic Science, Medicine, and Pathology

, Volume 13, Issue 2, pp 170–176 | Cite as

Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography

  • Garyfalia AmpanoziEmail author
  • Patricia M. Flach
  • Thomas D. Ruder
  • Laura Filograna
  • Wolf Schweitzer
  • Michael J. Thali
  • Lars C. Ebert
Original Article


The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as “aortic dissection”, “myocardial wall rupture” or “undetermined”. Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.


Virtopsy Forensic radiology Hemopericardium Postmortem computed tomography (PMCT) Aortic dissection Myocardial infarction 



The authors express their gratitude to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

Compliance with ethical standards

Conflicts of interest

The authors declare there is no conflict of interest.

Ethical approval

Ethical approval was obtained by the Cantonal Ethics Committee of Zurich, Nr. 90–2015.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Garyfalia Ampanozi
    • 1
    Email author
  • Patricia M. Flach
    • 1
  • Thomas D. Ruder
    • 1
    • 2
  • Laura Filograna
    • 3
    • 4
  • Wolf Schweitzer
    • 1
  • Michael J. Thali
    • 1
  • Lars C. Ebert
    • 1
  1. 1.Institute of Forensic Medicine, Department of Forensic Medicine and ImagingUniversity of ZurichZurichSwitzerland
  2. 2.Institute of Diagnostic, Interventional, and Pediatric RadiologyUniversity Hospital Bern, University of BernBernSwitzerland
  3. 3.Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation“Tor Vergata” University of RomeRomeItaly
  4. 4.Department of Radiological Sciences, PhD training program in Oncological Sciences, Catholic University of Rome, School of MedicineUniversity Hospital “A. Gemelli”RomeItaly

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