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Shimbashi S, Takeuchi A, Yoshimiya M, Jin S, Matoba K, Hyodoh H. Postmortem contrast-enhanced computed tomography via direct large-vessel puncture. Leg Med (Tokyo) 2024; 69:102448. [PMID: 38640871 DOI: 10.1016/j.legalmed.2024.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52-92) at the time of death. The mean time elapsed since death was 29.1 h (12.0-72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3-4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.
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Affiliation(s)
- Shogo Shimbashi
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Akiko Takeuchi
- Hokkaido University, Faculty of Medicine, Center for Cause of Death Investigation, Japan.
| | - Motoo Yoshimiya
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan.
| | - Shigeki Jin
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Kotaro Matoba
- Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
| | - Hideki Hyodoh
- University of Fukui School of Medical Sciences, Department of Forensic Medicine, Japan; Hokkaido University, Faculty of Medicine, Department of Forensic Medicine, Japan.
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Funayama K, Koyama A, Katsuragi-Go R, Aoyama T, Watanabe H, Takahashi N, Takatsuka H. Bleeding-Source Exploration in Subdural Hematoma: Observational Study on the Usefulness of Postmortem Computed Tomography Angiography. Diagnostics (Basel) 2023; 13:2286. [PMID: 37443680 DOI: 10.3390/diagnostics13132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
In a few cases, postmortem computed tomography angiography (PMCTA) is effective in postmortem detection of cortical artery rupture causing subdural hematoma (SDH), which is difficult to detect at autopsy. Here, we explore the usefulness and limitations of PMCTA in detecting the sites of cortical arterial rupture for SDH. In 6 of 10 cases, extravascular leakage of contrast material at nine different places enabled PMCTA to identify cortical arterial rupture. PMCTA did not induce destructive arterial artifacts, which often occur during autopsy. We found that, although not in all cases, PMCTA could show the site of cortical arterial rupture causing subdural hematoma in some cases. This technique is beneficial for cases of SDH autopsy, as it can be performed nondestructively and before destructive artifacts from the autopsy occur.
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Affiliation(s)
- Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Akihide Koyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Rieka Katsuragi-Go
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takashi Aoyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiraku Watanabe
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Naoya Takahashi
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, Niigata 951-8518, Japan
| | - Hisakazu Takatsuka
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata 951-8510, Japan
- Center of Cause of Death Investigation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Yoshida M, Makino Y, Hoshioka Y, Saito N, Yamaguchi R, Chiba F, Inokuchi G, Iwase H. Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy. J Forensic Sci 2021; 67:395-403. [PMID: 34491573 DOI: 10.1111/1556-4029.14883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as 'of internal origin' based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.
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Affiliation(s)
- Maiko Yoshida
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yohsuke Makino
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumi Hoshioka
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Naoki Saito
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumiko Chiba
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Go Inokuchi
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan
| | - Hirotaro Iwase
- Chiba University Center for Education and Research in Legal Medicine, Chiba, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Bertozzi G, Maglietta F, Sessa F, Scoto E, Cipolloni L, Di Mizio G, Salerno M, Pomara C. Traumatic Brain Injury: A Forensic Approach: A Literature Review. Curr Neuropharmacol 2020; 18:538-550. [PMID: 31686630 PMCID: PMC7457403 DOI: 10.2174/1570159x17666191101123145] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/27/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is the principal cause of invalidity and death in the population under 45 years of age worldwide. This mini-review aims to systematize the forensic approach in neuropathological studies, highlighting the proper elements to be noted during external, radiological, autoptical, and histological examinations with particular attention paid to immunohistochemistry and molecular biology. In the light of the results of this mini-review, an accurate forensic approach can be considered mandatory in the examination of suspected TBI with medico-legal importance, in order to gather all the possible evidence to corroborate the diagnosis of a lesion that may have caused, or contributed to, death. From this point of view, only the use of an evidence-based protocol can reach a suitable diagnosis, especially in those cases in which there are other neuropathological conditions (ischemia, neurodegeneration, neuro-inflammation, dementia) that may have played a role in death. This is even more relevant when corpses, in an advanced state of decomposition, are studied, where the radiological, macroscopic and histological analyses fail to give meaningful answers. In these cases, immune-histochemical and molecular biology diagnostics are of fundamental importance and a forensic neuropathologist has to know them. Particularly, MiRNAs are promising biomarkers for TBI both for brain damage identification and for medico-legal aspects, even if further investigations are required to validate the first experimental studies. In the same way, the genetic substrate should be examined during any forensic examination, considering its importance in the outcome of TBI.
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Affiliation(s)
| | | | | | | | | | | | | | - Cristoforo Pomara
- Address correspondence to this author at the Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy; Via S. Sofia 78, 95123 Catania, Italy; Tel: (39) 095.3782153; E-mail:
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