title: Pitfalls in post-mortem CT-angiography--intravascular contrast induces post-mortem pericardial effusion.
abstract: We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.
authors.affiliation: Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: nicole.berger@usz.ch.
authors.forename: Nicole
authors.initials: N
authors.lastname: Berger
authors.forename: Rosita
authors.initials: R
authors.lastname: Martinez
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winklhofer
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flach
authors.forename: Steffen
authors.initials: S
authors.lastname: Ross
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.forename: Dominic
authors.initials: D
authors.lastname: Gascho
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Ruder
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000792:Angiography / Q000009:adverse effects / Q000379:methods; D001344:Autopsy / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D049429:Forensic Pathology / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011180:Postmortem Changes; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014682:Vena Cava, Inferior / Q000293:injuries
chemical_list: D003287:Contrast Media
keywords: Artifact; Forensic radiology; Post-mortem computed tomography angiography; Vascular injury; Virtopsy