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Fukuda H, Hayakawa A, Takahashi Y, Komatsu Y, Kawamura M, Kubo R, Tokue H, Kominato Y, Sano R. Acute subdural hematoma caused by rupture of a mycotic aneurysm due to meningitis associated with infectious endocarditis: comparison of autopsy findings with postmortem computed tomography. Forensic Sci Med Pathol 2024; 20:657-663. [PMID: 37222902 DOI: 10.1007/s12024-023-00640-3] [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] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
Forensic pathologists often encounter cases of acute subdural hematoma (SDH) due to trauma, whereas those attributable to endogenous causes are rare. Here, we report a case of the latter type in a 42-year-old man who was found dead at home after several months of fever and malaise. Postmortem computed tomography (PMCT) and autopsy were undertaken to clarify the cause of death. PMCT images revealed a fatal SDH and a localized hyper-density area in the right parietal lobe; macroscopic and microscopic examinations revealed SDH due to rupture of a mycotic aneurysm (MA) associated with meningitis. The PMCT images also indicated thickening and calcification of the mitral valve, while autopsy demonstrated infective endocarditis (IE). In addition, PMCT demonstrated a low-density area in the spleen, which was shown to be a splenic abscess at autopsy. PMCT also demonstrated tooth cavities. Based on the findings of autopsy, the cause of death was considered to be SDH due to rupture of the MA resulting from meningitis with IE and splenic abscess. Although PMCT was unable to clarify the significance of any individual feature, a retrospective review of the PMCT images might have suggested IE, bacteremia, or ruptured MA leading to SDH. This case suggests that, instead of interpreting individual features demonstrated on PMCT images, integrated interpretation of overall PMCT findings might provide clues for identifying causes of death, despite the fact that PMCT lacks diagnostic accuracy for infectious diseases such as IE and meningitis.
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MESH Headings
- Humans
- Male
- Adult
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/pathology
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/pathology
- Aneurysm, Ruptured/pathology
- Aneurysm, Ruptured/diagnostic imaging
- Tomography, X-Ray Computed
- Autopsy
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/pathology
- Mitral Valve/pathology
- Mitral Valve/diagnostic imaging
- Endocarditis/pathology
- Endocarditis/diagnostic imaging
- Endocarditis/complications
- Meningitis/microbiology
- Postmortem Imaging
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Affiliation(s)
- Haruki Fukuda
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan.
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Yuka Komatsu
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
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Femia G, Langlois N, Raleigh J, Gray B, Othman F, Perumal SR, Semsarian C, Puranik R. Comparison of conventional autopsy with post-mortem magnetic resonance, computed tomography in determining the cause of unexplained death. Forensic Sci Med Pathol 2021; 17:10-18. [PMID: 33464532 DOI: 10.1007/s12024-020-00343-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Conventional autopsy is the gold standard for identifying unexplained death but due to declines in referrals, there is an emerging role for post-mortem imaging. We evaluated whether post-mortem magnetic resonance (PMMR) and computed tomography (PMCT) are inferior to conventional autopsy. Deceased individuals ≥ 2 years old with unexplained death referred for coronial investigation between October 2014 to December 2016 underwent PMCT and PMMR prior to conventional autopsy. Images were reported separately and then compared to the autopsy findings by independent and blinded investigators. Outcomes included the accuracy of imaging modalities to identify an organ system cause of death and other significant abnormalities. Sixty-nine individuals underwent post-mortem scanning and autopsy (50 males; 73%) with a median age of 61 years (IQR 50-73) and median time from death to imaging of 2 days (IQR 2-3). With autopsy, 48 (70%) had an organ system cause of death and were included in assessing primary outcome while the remaining 21 (30%) were only included in assessing secondary outcome; 12 (17%) had a non-structural cause and 9 (13%) had no identifiable cause. PMMR and PMCT identified the cause of death in 58% (28/48) of cases; 50% (24/48) for PMMR and 35% (17/48) for PMCT. The sensitivity and specificity were 57% and 57% for PMMR and 38% and 73% for PMCT. Both PMMR and PMCT identified 61% (57/94) of other significant abnormalities. Post-mortem imaging is inferior to autopsy but when reported by experienced clinicians, PMMR provides important information for cardiac and neurological deaths while PMCT is beneficial for neurological, traumatic and gastrointestinal deaths.
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Affiliation(s)
- Giuseppe Femia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia.
| | - Neil Langlois
- Forensic Science South Australia, SA, Adelaide, Australia
- School of Medical and Health Sciences, University of Adelaide, SA, Adelaide, Australia
| | - Jim Raleigh
- Department of Radiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Farrah Othman
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
| | - Sunthara Rajan Perumal
- South Australia Health & Medical Research Institute, Preclinical, Imaging & Research Laboratories, Adelaide, Australia
| | - Christopher Semsarian
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, The University of Sydney, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, 2050, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, NSW, Camperdown, Australia
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A review on the evolution and characteristics of post-mortem imaging techniques. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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