Abstract
Forensic scholars are paying more attention to postmortem computed tomography (PMCT) and PMCT angiography (PMCTA), which are gradually becoming effective and practical methods in forensic practice. However, few studies have focused on the application of PMCTA to cardiac ventricular puncture—especially of the right ventricle. In this article, we introduce a pulmonary PMCTA approach by right ventricle cardiac puncture and its potential value in fatalities from pulmonary thromboembolism (PTE). The procedure was performed on 11 males and 6 females. PMCT was performed first; then a biopsy core needle was used for percutaneous puncture of the right ventricle under CT guidance. About 400 mL of contrast media was injected at a rate of 50 mL/8 s, followed by CT scanning. Visualization of the pulmonary artery contrast filling was complete in 9 cadavers, and the pulmonary arteries showed significant filling defects in 8 subjects. Unlike in clinical practice, the phenomenon of postmortem coagulation sometimes occurs in the vascular lumina after death. Therefore, the results of these 8 cases can only suggest or be highly suspicious of death from PTE. Then autopsy and histopathological examination confirmed that 4 of the above 8 patients were diagnosed with PTE; the remaining 4 had postmortem clot including chicken fat clot in the pulmonary artery. Pulmonary PMCTA approach is a simple, convenient, and effective method for the visualization of the pulmonary artery, which can be used as an effective auxiliary tool to identify PTE in forensic practice. It will also provide technical support to further investigate PTE imaging characteristics.
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References
Burke MP, Bedford P, Baber Y (2014) Can forensic pathologists diagnose pulmonary thromboembolism on postmortem computed tomography pulmonary angiography? Am J Forensic Med Pathol 35(2):124–131
Fineschi V, Turillazzi E, Neri M, Pomara C, Riezzo I (2009) Histological age determination of venous thrombosis: a neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int 186(1-3):22–28
Lucena J, Rico A, Vázquez R, Marín R, Martínez C, Salguero M, Miguel L (2009) Pulmonary embolism and sudden–unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. J Forensic Legal Med 16(4):196–201
Margiotta G, Coletti A, Severini S, Tommolini F, Lancia M (2017)Medico-legal aspects of pulmonary thromboembolism. Adv Exp Med Biol 906:407–418
Adelman A, Vasserman M, Graziani G, Kugel C, Meir K, Bdolah-Abram T, Krispin A (2017)Post-mortem computed tomography compared to medico-legal autopsy – pathologies in the torso and limbs. J Forensic Radiol Imaging 12(2018):43–49
Daly B, Abboud S, Ali Z, Sliker C (2013) Comparison of whole-body post mortem 3D \\{CT\\} and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification. Forensic Sci Int 225(1-3):20–26
Sarah V, Plaetsen E, De L, Michel P, Geert V (2015)Post-mortem evaluation of drowning with whole body CT. Forensic Sci Int 249:35–41
Shao Y, Wan L, Zhang JH, Li ZD, Liu NG, Huang P, Zou DH, Chen YJ (2017)Post-mortem computed tomography angiography using left ventricle cardiac puncture: a whole-body, angiographic approach. PLoS One 12(8):e0183408
Wan L, Shao Y, Zou DH, Huang P, Li ZD, Wang MW, Chen YJ (2017) Diagnosis of coronary artery disease using targeted post-mortem computed tomography coronary angiography: a case report. Forensic Sci Res 2(2):107–111
Grabherr S, Gygax E, Sollberger B, Ross S, Oesterhelweg L, Bolliger S, Christe A, Djonov V, Thali M, Dirnhofer R (2008)Two-step postmortem angiography with a modified heart-lung machine: preliminary results. AJR Am J Roentgenol 190(2):345–351
Ross S, Spendlove D, Bolliger S, Christe A, Oesterhelweg L, Grabherr S, Thali M, Gygax E (2008) Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR Am J Roentgenol 190(5):1380–1389
Ruder TD, Ketterer T, Preiss U, Bolliger M, Ross S, Gotsmy WF, Ampanozi G, Germerott T, Thali MJ, Hatch GM (2011) Suicidal knife wound to the heart: challenges in reconstructing wound channels with post mortem CT and CT-angiography. Legal Med 13(2):91–94
Zhou S, Wan L, Shao Y, Ying CL, Wang YH, Zou DH, Xia WT, Chen YJ (2016) Detection of aortic rupture using post-mortem computed tomography and post-mortem computed tomography angiography by cardiac puncture. Int J Legal Med 130(2):469–474
Grabherr S, Grimm JM, Heinemann A (2016) Atlas of Postmortem Angiography. Springer International Publishing. https://doi.org/10.1007/978-3-319-28537-5
Grabherr S, Heinemann A, Vogel H, Rutty G, Morgan B, Woźniak K, Dedouit F, Fischer F, Lochner S, Wittig H, Guglielmi G, Eplinius F, Michaud K, Palmiere C, Chevallier C, Mangin P, Grimm J (2018) Postmortem CT angiography compared with autopsy: a forensic multicenter study. Radiology 288(1):270–276
Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P (2014) Advances in post-mortem CT-angiography. Br J Radiol 87(1036):20130488
Ampanozi G, Held U, Ruder TD, Ross SG, Schweitzer W, Fornaro J, Franckenberg S, Thali MJ, Flach PM (2016) Pulmonary thromboembolism on unenhanced postmortem computed tomography: feasibility and findings. Legal Med 20:68–74
Pomara C, Bello S, Grilli G, Guglielmi G, Turillazzi E (2015)Multi-phase postmortem CT angiography (MPMCTA): a new axillary approach suitable in fatal thromboembolism. Radiol Med 120(7):670–673
Von Both I, Bruni SG, Herath JC (2018) Differentiation of antemortem pulmonary thromboembolism and postmortem clot with unenhanced MRI: a case report. Forensic Sci Med Pathol 14:95–101
Lecun Y, Bengio Y, Hinton G (2015) Deep learning. Nature 521(7553):436–444
Sarraf S, Tofighi G (2016) Classification of Alzheimer’s disease structural MRI data by deep learning convolutional neural networks
Spampinato C, Palazzo S, Giordano D, Aldinucci M, Leonardi R (2017) Deep learning for automated skeletal bone age assessment in X-ray images. Med Image Anal 36:41–51
Nardelli P, Jimenez-Carretero D, Bermejo-Pelaez D, Washko GR, Rahaghi FN, Ledesma-Carbayo MJ, Estépar RSJ (2018) Pulmonary artery–vein classification in CT images using deep learning. IEEE Trans Med Imaging 37(11):2428–2440
Funding
The study was financially supported by grants from the National Key Research and Development Plan (2016YFC0800702), Council of National Science Foundation of China (81701863, 81722027, 81571851), Shanghai Key Laboratory of Forensic Medicine (17DZ2273200), Shanghai Forensic Service Platform (19DZ2290900), and Central Research Institute Public Project (GY2019Z-2, GY2017G-4).
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The study complies with current ethical consideration. Informed consent to publish the article was obtained from the family, and this study was approved by the Academic Committee of the Academy of Forensic Science, Ministry of Justice, People’s Republic of China.
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Tian, ZL., Wang, ZQ., Liu, NG. et al. Pulmonary PMCT angiography by right ventricle cardiac puncture: a novel, promising approach for investigating pulmonary thromboembolism. Int J Legal Med 135, 913–920 (2021). https://doi.org/10.1007/s00414-020-02476-w
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DOI: https://doi.org/10.1007/s00414-020-02476-w