title: Use of postmortem computed tomography angiography to detect vascular injuries accompanying skull base fracture.
abstract: A 58-year-old woman who had presented for upper gastrointestinal barium examination accidently slipped from the movable bed, and her head became compressed between the end of the bed and the side wall. She suffered massive bleeding from her nose and ear followed by cardiac arrest, and subsequent attempts at cardiopulmonary resuscitation failed. A medicolegal autopsy was performed to reveal the cause of death, as part of the investigation of the accident. During the autopsy, postmortem cerebral CT angiography was carried out by injection of 5% gelatin-barium emulsion as a radiopaque contrast medium into the bilateral common carotid arteries, demonstrating transudation of the contrast medium into the right acoustic meatus and the sphenoidal sinus cavity. Considering that the body appeared anemic and that PMCTA suggested vascular injuries, the cause of death was definitively determined to be hemorrhagic shock due to injuries to the right internal carotid artery, accompanied by skull base fracture. Postmortem CT angiography played an important role in confirming that the vascular injuries had been responsible for the bleeding, as the lesions could not be fully confirmed by native CT or macroscopic examination.
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kuninaka
authors.affiliation: Department of Legal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan. Electronic address: y.takahashi@gunma-u.ac.jp.
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.
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: Rieko
authors.initials: R
authors.lastname: Kubo
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: D001344:Autopsy; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D005260:Female; D050723:Fractures, Bone / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D019291:Skull Base / Q000098:blood supply*; D057772:Vascular System Injuries / Q000473:pathology*
keywords: Postmortem computed tomography; Skull base fracture; Targeted postmortem CT angiography