title: Demonstration of liver metastases on postmortem whole body CT angiography following inadvertent systemic venous infusion of the contrast medium.
abstract: An 86-year-old woman was hospitalized for breathlessness and a large right-sided pleural effusion. Approximately 1 h after thoracentesis, she developed a hemothorax resulting in hypotension and death. Routine postmortem CT scanning showed a large volume right hemothorax and a markedly enlarged liver. In an attempt to determine the origin of bleeding prior to autopsy, a postmortem CT angiogram was performed. Following inadvertent cannulation of the left long saphenous vein and infusion of ∼1,700 mL of a polyethylene glycol 200 and iodine-based radiographic contrast solution into systemic veins using a mechanical pump, CT scanning revealed a dense hepatic "parenchogram" containing multiple large, filling defects indicative of metastases. These were confirmed at autopsy. Microscopic evaluation of the liver using hematoxylin and eosin staining showed marked histological artifact characterized by centrilobular sinusoidal expansion although histology of the adenocarcinoma metastases was typical and apparently unaffected by the contrast solution. Postmortem CT angiography using an aqueous radiographic contrast agent in the so-called venous phase seems to be useful for the identification of hepatic parenchymal metastatic disease although it does cause histological artifact.
authors.affiliation: Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University, Southbank, VIC, Australia. chriso@vifm.org
authors.forename: Chris
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hislop-Jambrich
authors.forename: Noel
authors.initials: N
authors.lastname: Woodford
authors.forename: Melissa
authors.initials: M
authors.lastname: Baker
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D000369:Aged, 80 and over; D000792:Angiography; D016477:Artifacts; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D003110:Colonic Neoplasms / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D019152:Paracentesis; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology; D011180:Postmortem Changes; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media