title: Detection of hemorrhage source: the diagnostic value of post-mortem CT-angiography.
abstract: The aim of this study was to compare the diagnostic value of post-mortem computed tomography angiography (PMCTA) to conventional, ante-mortem computed tomography (CT)-scan, CT-angiography (CTA) and digital subtraction angiography (DSA) in the detection and localization of the source of bleeding in cases of acute hemorrhage with fatal outcomes. The medical records and imaging scans of nine individuals who underwent a conventional, ante-mortem CT-scan, CTA or DSA and later died in the hospital as a result of an acute hemorrhage were reviewed. Post-mortem computed tomography angiography, using multi-phase post-mortem CTA, as well as medico-legal autopsies were performed. Localization accuracy of the bleeding was assessed by comparing the diagnostic findings of the different techniques. The results revealed that data from ante-mortem and post-mortem radiological examinations were similar, though the PMCTA showed a higher sensitivity for detecting the hemorrhage source than did ante-mortem radiological investigations. By comparing the results of PMCTA and conventional autopsy, much higher sensitivity was noted in PMCTA in identifying the source of the bleeding. In fact, the vessels involved were identified in eight out of nine cases using PMCTA and only in three cases through conventional autopsy. Our study showed that PMCTA, similar to clinical radiological investigations, is able to precisely identify lesions of arterial and/or venous vessels and thus determine the source of bleeding in cases of acute hemorrhages with fatal outcomes.
authors.affiliation: University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland. cristian.palmiere@chuv.ch
authors.forename: C
authors.initials: C
authors.lastname: Palmiere
authors.forename: S
authors.initials: S
authors.lastname: Binaghi
authors.forename: F
authors.initials: F
authors.lastname: Doenz
authors.forename: P
authors.initials: P
authors.lastname: Bize
authors.forename: C
authors.initials: C
authors.lastname: Chevallier
authors.forename: P
authors.initials: P
authors.lastname: Mangin
authors.forename: S
authors.initials: S
authors.lastname: Grabherr
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015901:Angiography, Digital Subtraction; D001344:Autopsy; D005260:Female; D049429:Forensic Pathology; D006470:Hemorrhage / Q000209:etiology*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D010388:Pelvis / Q000098:blood supply; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D054063:Superior Sagittal Sinus / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult