title: Use of postmortem coronary computed tomography angiography with water-insoluble contrast medium to detect stenosis of the left anterior descending artery in a case of sudden death.
abstract: A 40-year-old man was found dead on a sidewalk in an expressway parking area one hour after he had entered the area on a motorcycle. A medicolegal autopsy was performed to reveal the cause of this sudden and unexpected death. Postmortem coronary CT angiography after introduction of 5% gelatin-barium emulsion as a radiopaque contrast medium into the heart demonstrated a significant arterial luminal filling defect in the left anterior descending (LAD) coronary artery. Macroscopic and microscopic examinations revealed that a thrombus had become deposited on ruptured plaque within the LAD artery, and that a small amount of the contrast medium was present between the thrombus and the vessel endothelium. These histological findings were consistent with incomplete occlusion of the LAD artery in the 3D reconstructed image. The cause of death in this case was definitively determined to be ischemic heart disease. Postmortem angiography played a role in screening of a vascular lesion that was subsequently verified by histology to have been responsible for sudden and unexpected death.
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan. Electronic address: takagirie@gunma-u.ac.jp.
authors.forename: Rie
authors.initials: R
authors.lastname: Sano
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kominato
authors.affiliation: Department of Radiology, Gunma University Hospital, Maebashi 371-8511, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takei
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tokue
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Awata
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirasawa
mesh_terms: D000328:Adult; D001344:Autopsy; D001466:Barium Sulfate; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging*; D016757:Death, Sudden, Cardiac; D005780:Gelatin; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate; D005780:Gelatin
keywords: Barium; Ischemic heart disease; Postmortem coronary CT angiography; Sudden death; Thrombus