title: Detection of the source of hemorrhage using postmortem computerized tomographic angiography in a case of a giant juvenile nasopharyngeal angiofibroma after surgical treatment.
abstract: OBJECTIVE
  Postmortem computerized tomographic angiography (PMCTA) has been increasingly used in forensic medicine to detect and locate the source of bleeding in cases of fatal acute hemorrhage. In this paper, we report a case of postoperative complication in a patient with a giant juvenile nasopharyngeal angiofibroma in which the source of bleeding was detected by PMCTA.
  
  
  METHODS
  A case description and evaluations of the pre- and postoperative exams, postmortem CT angiogram, and conventional autopsy results are provided.
  
  
  RESULTS
  The source of bleeding was identified by postmortem CT angiography but not by conventional autopsy. The established protocol, injecting contrast medium into the femoral artery, was effective in identifying the source of bleeding.
  
  
  CONCLUSIONS
  Postoperative bleeding is a rare and frequently fatal complication of juvenile nasopharyngeal angiofibroma. As a complement to conventional autopsy, postmortem angiography is a valuable tool for the detection of lethal acute hemorrhagic foci, and establishing a routine procedure for PMCTA may improve its efficiency.
authors.affiliation: Radiology Institute, Hospital of Clinics, São Paulo University Medical School, São Paulo, Brazil, fbpnascimento@gmail.com.
authors.forename: Felipe Barjud Pereira
authors.initials: FB
authors.lastname: do Nascimento
authors.forename: Glaucia Aparecida Bento
authors.initials: GA
authors.lastname: dos Santos
authors.forename: Nelson Almeida d'Ávila
authors.initials: NA
authors.lastname: Melo
authors.forename: Eduarda Bittencourt
authors.initials: EB
authors.lastname: Damasceno
authors.forename: Thais
authors.initials: T
authors.lastname: Mauad
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000601:surgery*; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D012769:Shock / Q000209:etiology
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine