title: Forensic relevance of post-mortem CT imaging of the haemopericardium in determining the cause of death.
abstract: The post-mortem diagnosis of pericardial tamponade is associated with several medical legal problems. Thus, we explored whether post-mortem computed tomography might provide useful and reliable information for the diagnosis of this relevant disease in combination with autopsy data. We retrospectively reviewed the post-mortem computed tomography and autopsy reports of 15 autopsy cases with haemopericardium detected at the Institute of Forensic Medicine in Berne from July 2005 to February 2010. Two computer tomography findings were examined in combination with autopsy results. The first was the "hyperdense armoured heart," which has been previously described as post-mortem evidence of heart beating for a time after the initiation of intrapericardial bleeding. The second was the "flattening of the anterior surface" of the heart which has been previously observed in vivo as a sign of the compression effect of the haemopericardium on the heart. Our retrospective analysis showed the combined presence of both of these findings in all cases of autopsy evidence of pericardial tamponade with the exception of one case. In contrast, the concomitance of both of them was never observed in cases of autopsy death due to haemorrhage in which neither the flattening of the anterior surface of the heart was detected except for one case. In conclusion, these results should be considered a first step toward the potentially using post-mortem computed tomography in combination with autopsy data in the diagnosis of pericardial tamponade especially considering the possibility to detect sign as the flattened heart signal which cannot be assessed after opening the pericardium at autopsy.
authors: Institute of Radiology, Department of Radiological Sciences, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy; Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Forensic Medicine, Centre of Forensic Imaging and Virtopsy, University of Berne, Bühlstrasse, 20, 3012 Bern, Switzerland. Electronic address: laura.filograna@irm.uzh.ch.
authors: Laura
authors: L
authors: Filograna
authors: Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Forensic Medicine, Centre of Forensic Imaging and Virtopsy, University of Berne, Bühlstrasse, 20, 3012 Bern, Switzerland.
authors: Michael J
authors: MJ
authors: Thali
authors: Institute of Public Health, Legal Medicine Section, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy.
authors: Daniela
authors: D
authors: Marchetti
mesh_terms: D001344:Autopsy; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging*; D002423:Cause of Death; D005554:Forensic Medicine; D006801:Humans; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Cardiac tamponade; Haemopericardium; Pericardial tamponade; Post-mortem computer tomography