title: Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis.
abstract: A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.
authors.affiliation: Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: ccapuani@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Capuani
authors.affiliation: Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: guilbeau-frugier.c@chu-toulouse.fr.
authors.forename: Céline
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.affiliation: Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: mokrane.fz@chu-toulouse.fr.
authors.forename: Fatima-Zohra
authors.initials: FZ
authors.lastname: Mokrane
authors.affiliation: Service d'Anatomie Pathologique et Histologie-Cytologie, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: delisle.b@chu-toulouse.fr.
authors.forename: Marie-Bernadette
authors.initials: MB
authors.lastname: Delisle
authors.affiliation: Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: marcheix.b@chu-toulouse.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.affiliation: Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: rousseau.h@chu-toulouse.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.affiliation: Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: telmon.n@chu-toulouse.fr.
authors.forename: Norbert
authors.initials: N
authors.lastname: Telmon
authors.affiliation: Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: rouge.d@chu-toulouse.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rougé
authors.affiliation: Service de Radiologie Centrale, Centre Hospitalier Universitaire Rangueil-Larrey, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France; Unité Médico-Judiciaire, Centre Hospitalier Universitaire Rangueil, 1 avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France. Electronic address: dedouit.f@chu-toulouse.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Dedouit
mesh_terms: D000328:Adult; D000792:Angiography; D016477:Artifacts; D003287:Contrast Media; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D061330:Multidetector Computed Tomography; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011650:Pulmonary Alveoli / Q000473:pathology; D012131:Respiratory Insufficiency / Q000209:etiology; D056647:Systemic Vasculitis / Q000175:diagnosis*; D013699:Temporal Arteries / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Contrast agent; Conventional autopsy; Diffuse alveolar damage; Microscopy; Post-mortem CT angiography; Vasculitis