Limits...
Myocardial Contrast Defect Associated with Thrombotic Coronary Occlusion: Pre-Autopsy Diagnosis of a Cardiac Death with Post-Mortem CT Angiography.

Lee H, Park H, Cha JG, Lee S, Yang K - Korean J Radiol (2015)

Bottom Line: We report the case of a female who died of suspected acute myocardial infarction.Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium.We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Bucheon 14584, Korea.

ABSTRACT
We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

No MeSH data available.


Related in: MedlinePlus

Post-mortem CT angiography and pathologic specimen of 59-year-old female who died of suspected myocardial infarction.A. Curved multiplanar reformation (MPR, left) and three-dimensional volume rendering image (right) demonstrate aortic dissection with intimo-medial flap and thrombosed false lumen (arrowheads) from aortic arch extending to left common iliac artery. Autopsy confirmed ascending aortic replacement due to previous type A aortic dissection. B, C. Curved MPR (B) and medial axial reformat (C) images of coronary tree show total thrombotic occlusion of stents (arrowheads) in right coronary artery (RCA) and RCA itself (arrow), and also depict focal mixed plaque (arrow) in proximal left anterior descending artery (LAD) and normal left circumflex artery (LCx). Note postmortem clots (*) in pulmonary artery. D. Multiple short-axis views of left ventricle (LV) show localized transmural perfusion defects (arrows) in inferior and inferoseptal walls of mid and basal LV, sharply demarcated from normal myocardium showing diffuse contrast enhancement (upper). Perfusion defects correspond to thrombosed RCA (arrowhead) territory with apical sparing (*) clearly depicted on two-chamber view (lower column).E. Density measurements in short axis image demonstrate considerable contrast enhancement in normal myocardium, that can be attributed to compact filling of oily contrast agent in micro-capillary system through patent LAD and LCx coronary arteries. Note huge postmortem clot (*) in right ventricle. F. Gross and microscopic specimens of heart. Cut surface shows subtle mottling with yellow-tan softening in damaged inferoseptal wall (arrow), which has typical microscopic changes of coagulation necrosis with focal interstitial infiltrate of neutrophils, indicative of acute myocardial infarction (left upper). LAD = left anterior descending artery, LCx = left circumflex artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4559773&req=5

Figure 1: Post-mortem CT angiography and pathologic specimen of 59-year-old female who died of suspected myocardial infarction.A. Curved multiplanar reformation (MPR, left) and three-dimensional volume rendering image (right) demonstrate aortic dissection with intimo-medial flap and thrombosed false lumen (arrowheads) from aortic arch extending to left common iliac artery. Autopsy confirmed ascending aortic replacement due to previous type A aortic dissection. B, C. Curved MPR (B) and medial axial reformat (C) images of coronary tree show total thrombotic occlusion of stents (arrowheads) in right coronary artery (RCA) and RCA itself (arrow), and also depict focal mixed plaque (arrow) in proximal left anterior descending artery (LAD) and normal left circumflex artery (LCx). Note postmortem clots (*) in pulmonary artery. D. Multiple short-axis views of left ventricle (LV) show localized transmural perfusion defects (arrows) in inferior and inferoseptal walls of mid and basal LV, sharply demarcated from normal myocardium showing diffuse contrast enhancement (upper). Perfusion defects correspond to thrombosed RCA (arrowhead) territory with apical sparing (*) clearly depicted on two-chamber view (lower column).E. Density measurements in short axis image demonstrate considerable contrast enhancement in normal myocardium, that can be attributed to compact filling of oily contrast agent in micro-capillary system through patent LAD and LCx coronary arteries. Note huge postmortem clot (*) in right ventricle. F. Gross and microscopic specimens of heart. Cut surface shows subtle mottling with yellow-tan softening in damaged inferoseptal wall (arrow), which has typical microscopic changes of coagulation necrosis with focal interstitial infiltrate of neutrophils, indicative of acute myocardial infarction (left upper). LAD = left anterior descending artery, LCx = left circumflex artery

Mentions: Post-mortem CT angiography at the arterial phase (a retrograde injection of the contrast mixture into the arterial system through the femoral artery) demonstrated an aortic dissection with a contrast-filled true lumen and thrombosed false lumen (Fig. 1A). Furthermore, multiplanar reconstructed (MPR) images of the coronary tree showed a normal contrast-filled lumen of the left anterior descending and circumflex artery with their smaller branches. However, MPR images of the RCA clearly demonstrated complete thrombosis of os to distal segment, and also depicted complete occlusion of both stents implanted in proximal and distal segment, respectively (Fig. 1B, C). In addition, the short-axis view of the heart showed diffuse contrast enhancement of the left ventricular (LV) myocardium; interestingly, it also depicted a transmural contrast defect localized in the inferior and inferoseptal myocardium of the middle and basal LV that corresponds to the RCA territory (Fig. 1D, E).


Myocardial Contrast Defect Associated with Thrombotic Coronary Occlusion: Pre-Autopsy Diagnosis of a Cardiac Death with Post-Mortem CT Angiography.

Lee H, Park H, Cha JG, Lee S, Yang K - Korean J Radiol (2015)

Post-mortem CT angiography and pathologic specimen of 59-year-old female who died of suspected myocardial infarction.A. Curved multiplanar reformation (MPR, left) and three-dimensional volume rendering image (right) demonstrate aortic dissection with intimo-medial flap and thrombosed false lumen (arrowheads) from aortic arch extending to left common iliac artery. Autopsy confirmed ascending aortic replacement due to previous type A aortic dissection. B, C. Curved MPR (B) and medial axial reformat (C) images of coronary tree show total thrombotic occlusion of stents (arrowheads) in right coronary artery (RCA) and RCA itself (arrow), and also depict focal mixed plaque (arrow) in proximal left anterior descending artery (LAD) and normal left circumflex artery (LCx). Note postmortem clots (*) in pulmonary artery. D. Multiple short-axis views of left ventricle (LV) show localized transmural perfusion defects (arrows) in inferior and inferoseptal walls of mid and basal LV, sharply demarcated from normal myocardium showing diffuse contrast enhancement (upper). Perfusion defects correspond to thrombosed RCA (arrowhead) territory with apical sparing (*) clearly depicted on two-chamber view (lower column).E. Density measurements in short axis image demonstrate considerable contrast enhancement in normal myocardium, that can be attributed to compact filling of oily contrast agent in micro-capillary system through patent LAD and LCx coronary arteries. Note huge postmortem clot (*) in right ventricle. F. Gross and microscopic specimens of heart. Cut surface shows subtle mottling with yellow-tan softening in damaged inferoseptal wall (arrow), which has typical microscopic changes of coagulation necrosis with focal interstitial infiltrate of neutrophils, indicative of acute myocardial infarction (left upper). LAD = left anterior descending artery, LCx = left circumflex artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559773&req=5

Figure 1: Post-mortem CT angiography and pathologic specimen of 59-year-old female who died of suspected myocardial infarction.A. Curved multiplanar reformation (MPR, left) and three-dimensional volume rendering image (right) demonstrate aortic dissection with intimo-medial flap and thrombosed false lumen (arrowheads) from aortic arch extending to left common iliac artery. Autopsy confirmed ascending aortic replacement due to previous type A aortic dissection. B, C. Curved MPR (B) and medial axial reformat (C) images of coronary tree show total thrombotic occlusion of stents (arrowheads) in right coronary artery (RCA) and RCA itself (arrow), and also depict focal mixed plaque (arrow) in proximal left anterior descending artery (LAD) and normal left circumflex artery (LCx). Note postmortem clots (*) in pulmonary artery. D. Multiple short-axis views of left ventricle (LV) show localized transmural perfusion defects (arrows) in inferior and inferoseptal walls of mid and basal LV, sharply demarcated from normal myocardium showing diffuse contrast enhancement (upper). Perfusion defects correspond to thrombosed RCA (arrowhead) territory with apical sparing (*) clearly depicted on two-chamber view (lower column).E. Density measurements in short axis image demonstrate considerable contrast enhancement in normal myocardium, that can be attributed to compact filling of oily contrast agent in micro-capillary system through patent LAD and LCx coronary arteries. Note huge postmortem clot (*) in right ventricle. F. Gross and microscopic specimens of heart. Cut surface shows subtle mottling with yellow-tan softening in damaged inferoseptal wall (arrow), which has typical microscopic changes of coagulation necrosis with focal interstitial infiltrate of neutrophils, indicative of acute myocardial infarction (left upper). LAD = left anterior descending artery, LCx = left circumflex artery
Mentions: Post-mortem CT angiography at the arterial phase (a retrograde injection of the contrast mixture into the arterial system through the femoral artery) demonstrated an aortic dissection with a contrast-filled true lumen and thrombosed false lumen (Fig. 1A). Furthermore, multiplanar reconstructed (MPR) images of the coronary tree showed a normal contrast-filled lumen of the left anterior descending and circumflex artery with their smaller branches. However, MPR images of the RCA clearly demonstrated complete thrombosis of os to distal segment, and also depicted complete occlusion of both stents implanted in proximal and distal segment, respectively (Fig. 1B, C). In addition, the short-axis view of the heart showed diffuse contrast enhancement of the left ventricular (LV) myocardium; interestingly, it also depicted a transmural contrast defect localized in the inferior and inferoseptal myocardium of the middle and basal LV that corresponds to the RCA territory (Fig. 1D, E).

Bottom Line: We report the case of a female who died of suspected acute myocardial infarction.Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium.We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Soonchunhyang University Hospital, Bucheon 14584, Korea.

ABSTRACT
We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

No MeSH data available.


Related in: MedlinePlus