Skip to main content
SpringerLink
Log in

Systematic analysis of the radiologic findings of aortic dissections on unenhanced postmortem computed tomography

  • Original Article
  • Published:
Forensic Science, Medicine, and Pathology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the diagnostic criteria and to identify the radiological signs (derived from known radiological signs) for the detection of aortic dissections using postmortem computed tomography (PMCT). Thirty-three aortic dissection cases were retrospectively evaluated; all underwent PMCT and autopsy. The images were initially evaluated independently by two readers and were subsequently evaluated in consensus. Known radiological signs, such as dislocated calcification and an intimomedial flap, were identified. The prevalence of the double sedimentation level in the true and false lumen of the dissected aorta was assessed and defined as a postmortem characteristic sign of aortic dissection. Dislocated calcification was detected in 85 % of the cases with aortic calcification; whereas in 54 % of the non-calcified aortas, the intimomedial flap could also be recognized. Double sedimentation was identified in 16/33 of the cases. Overall, in 76 % (25/33) of the study cases, the described signs, which are indicative for aortic dissection, could be identified. In this study, three diagnostic criteria of aortic dissection were identified using non-enhanced PMCT images of autopsy-confirmed dissection cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lovy AJ, Rosenblum JK, Levsky JM, Godelman A, Zalta B, Jain VR, Haramati LB. Acute aortic syndromes: a second look at dual-phase CT. AJR. 2013;200:805–11.

    Article  PubMed Central  PubMed  Google Scholar 

  2. McMahon MA, Squirrell CA. FRCR Multidetector CT of aortic dissection: a pictorial review. Radiographics. 2010;30:445–60.

    Article  PubMed  Google Scholar 

  3. Lempel JK, Frazier AA, Jeudy J, Kligerman SJ, Schultz R, Ninalowo HA, Gozansky EK, Griffith B, White CS. Aortic arch dissection: a controversy of classification. Radiology. 2014;271(3):848–55.

    Article  PubMed  Google Scholar 

  4. Loebe M, Ren D, Rodriguez L, La Francesca S, Bismuth J, Lumsden A. Acute and chronic thoracic aortic disease: surgical considerations. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(4):243–50.

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Kapoor V, Ferris JV, Fuhrman CR. Intimomedial rupture: a new CT finding to distinguish true from false lumen in aortic dissection. AJR. 2004;183:109–12.

    Article  PubMed  Google Scholar 

  6. Yoo SM, Lee HY, White CS. MDCT evaluation of acute aortic syndrome. Radiol Clin N Am. 2010;48:67–83.

    Article  PubMed  Google Scholar 

  7. Bonaca MP, O’Gara PT. Diagnosis and management of acute aortic syndromes: dissection, intramural hematoma, and penetrating aortic ulcer. Curr Cardiol Rep. 2014;16(10):1–13.

    Article  Google Scholar 

  8. Macura KJ, Corl FM, Fishman EK, et al. Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. Am J Roentgenol. 2003;181:309–16.

    Article  Google Scholar 

  9. Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin. 1999;17(4):637–57.

    Article  CAS  PubMed  Google Scholar 

  10. Sebastià C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A. Aortic dissection: diagnosis and follow up with helical CT. Radiographics. 1999;19:45–60.

    Article  PubMed  Google Scholar 

  11. Divchev D, Najjar T, Tillwich F, Aboukoura M, Rehders T, Nienaber CA. Risk assessment of acute aortic dissection. Dtsch Med Wochenschr. 2014;139(39):1947–51.

    Article  CAS  PubMed  Google Scholar 

  12. Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, Szep L. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271–8.

    Article  CAS  PubMed  Google Scholar 

  13. Proudfoot D, Shanahan CM. Biology of calcification in vascular cells: intima versus media. Herz. 2001;26:245–51.

    Article  CAS  PubMed  Google Scholar 

  14. Burke M, Parsons S, Bassed R. Management of medicolegal natural deaths from hemopericardium or hemothorax using postmortem CT scanning. Forensic Sci Med Pathol. 2012;8(4):367–72.

    Article  PubMed  Google Scholar 

  15. Takahashi K, Stanford W. Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 2005;21:141–53.

    Article  PubMed  Google Scholar 

  16. Zeina AR, Trachtengerts V, Abadi S, Jarchowsky J, Soimu U, Nachtigal A. Thoraco-abdominal aorta dissection: look again before you leap. Radiol Case Rep. 2009;3(9):29–33.

    Google Scholar 

  17. Schyma C, Hagemeier L, Madea B. Bloodless aortic dissection. Forensic Sci Med Pathol. 2013;9:221–4.

    Article  CAS  PubMed  Google Scholar 

  18. Sato Y, Satokawa H, Takase S, Misawa Y, Yokoyama H. Prolapse of aortic intimal flap into the left ventricle. A rare cause of global myocardial ischemia in acute type A aortic dissection. Circ J. 2006;70:214–5.

    Article  PubMed  Google Scholar 

  19. Baglivo M, Winklhofer S, Hatch GM, Ampanozi G, Thali MJ, Ruder TD. The rise of forensic and post-mortem radiology—Analysis of the literature between the year 2000 and 2011. J Forensic Radiol Imaging. 2013;1:3–9.

    Article  Google Scholar 

  20. Bedford PJ, Oesterhelweg L. Different conditions and strategies to utilize forensic radiology in the cities of Melbourne, Australia and Berlin, Germany. Forensic Sci Med Pathol. 2013;9:321–6.

    Article  PubMed  Google Scholar 

  21. Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P. Virtual autopsy using imaging: bridging radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol. 2008;18(2):273–82.

    Article  PubMed  Google Scholar 

  22. Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics. 2014;34:830–46.

    Article  PubMed  Google Scholar 

  23. Shiotani S, Kohno M, Ohashi N, Yamazaki K, Nakayama H, Ito Y, Kaga K, Ebashi T, Itai Y. Hyperattenuating aortic wall on postmortem computed tomography (PMCT). Radiat Med. 2002;20(4):201–6.

    PubMed  Google Scholar 

  24. Shiotani S, Kohno M, Ohashi N, Yamazaki K, Itai Y. Postmortem intravascular high-density fluid level (hypostasis): CT findings. J Comput Assist Tomogr. 2002;26(6):892–3.

    Article  PubMed  Google Scholar 

  25. Thali MJ, Viner MD, Brogdon BG. Brogdon’s forensic radiology. 2nd ed. Boca Raton: CRC Press; 2011.

    Google Scholar 

  26. Schwendener N, Mund M, Jackowski C. Type II DeBakey dissection with complete aortic rupture visualized by unenhanced postmortem imaging. Forensic Sci Int. 2013;225:67–70.

    Article  PubMed  Google Scholar 

  27. Lardi C, Lobrinus JA, Doenz F, Fracasso T, Augsburger M, Mangin P, Grabherr S. Acute aortic dissection with carotid and coronary malperfusion. From imaging to pathology. Am J Forensic Med Pathol. 2014;35:157–62.

    Article  PubMed  Google Scholar 

  28. Kluschke F, Ross S, Flach PM, Schweitzer W, Ampanozi G, Gascho D, Vonlanthen B, Thali MJ, Ruder TD. To see or not to see—Ambiguous findings on post-mortem cross-sectional imaging in a case of ruptured abdominal aortic aneurysm. Leg Med (Tokyo). 2013;15:256–9.

    Article  PubMed  Google Scholar 

  29. Flach PM, Gascho D, Schweitzer W, Ruder TD, Berger N, Ross SG, Thali MJ, Ampanozi G. Imaging in forensic radiology: an illustrated guide for postmortem computed tomography technique and protocols. Forensic Sci Med Pathol. 2014;10(4):583–606.

    Article  PubMed  Google Scholar 

  30. Hallinan JTPD, Anil G. Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes. World J Radiol. 2014;6(6):355–65.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Demos TC, Posniak HV, Churchill RJ. Detection of the intimal flap of aortic dissection on unenhanced CT images. AJR. 1986;146:601–3.

    Article  CAS  PubMed  Google Scholar 

  32. Jackowski C, Thali M, Aghayev E, Yen K, Sonnenschein M, Zwygart K, Dirnhofer R, Vock P. Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med. 2006;120:233–40.

    Article  CAS  PubMed  Google Scholar 

  33. Tsai TT, Evangelista A, Nienaber CA, Myrmel T, Meinhardt G, Cooper JV, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357(4):349–59.

    Article  CAS  PubMed  Google Scholar 

  34. Bailey K, Duflou J, Puranik R. Fatal cases of aortic dissection: an autopsy study. Int J Cardiol. 2012;158(1):148–9.

    Article  CAS  PubMed  Google Scholar 

  35. Christe A, Flach P, Ross S, Spendlove D, Bolliger S, Vock P, Thali MJ. Clinical radiology and postmortem imaging (Virtopsy) are not the same: specific and unspecific postmortem signs. Leg Med (Tokyo). 2010;12:215–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland

    Garyfalia Ampanozi, Patricia M. Flach, Juergen Fornaro, Steffen G. Ross, Wolf Schweitzer, Michael J. Thali & Thomas D. Ruder

  2. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 4, 3010, Bern, Switzerland

    Thomas D. Ruder

Authors
  1. Garyfalia Ampanozi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia M. Flach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juergen Fornaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steffen G. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolf Schweitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Thali
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas D. Ruder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Garyfalia Ampanozi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ampanozi, G., Flach, P.M., Fornaro, J. et al. Systematic analysis of the radiologic findings of aortic dissections on unenhanced postmortem computed tomography. Forensic Sci Med Pathol 11, 162–167 (2015). https://doi.org/10.1007/s12024-015-9654-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-015-9654-z

Keywords

Search

Navigation