Post-mortem changes of the vascular system-a thanatological study using multidetector computed tomography.
Post-mortem MDCT
Post-mortem changes
Thanatology
Vascular system
Journal
International journal of legal medicine
ISSN: 1437-1596
Titre abrégé: Int J Legal Med
Pays: Germany
ID NLM: 9101456
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
06
12
2022
accepted:
06
04
2023
medline:
9
6
2023
pubmed:
26
4
2023
entrez:
26
4
2023
Statut:
ppublish
Résumé
Forensic pathologists have to deal with post-mortem changes of the human body. Those post-mortem phenomena are familiar and largely described in thanatology. However, knowledge about the influence of post-mortem phenomena on the vascular system is more limited, except for the apparition and development of cadaveric lividity. The introduction of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the forensic field and the expansion of their usage in medico-legal routine, allow for exploring the inside of corpses differently and may play a part in the understanding of thanatological processes. This study aimed to describe post-mortem changes in the vascular system by investigating the presence of gas and collapsed vessels.We investigated post-mortem MDCT data of 118 human bodies. Cases with internal/external bleeding or corporal lesion allowing contamination with external air were excluded. Major vessels and heart cavities were systematically explored and a trained radiologist semi-quantitatively assessed the presence of gas.Collapsed veins were observed in 61.9% of cases (CI95% 52.5 to 70.6) and arteries in 33.1% (CI95% 24.7 to 42.3). Vessels most often affected were for arteries: common iliac (16.1%), abdominal aorta (15.3%), external iliac (13.6%), and for veins: infra-renal vena cava (45.8%), common iliac (22.0%), renal (16.9%), external iliac (16.1%), and supra-renal vena cava (13.6%). Cerebral arteries and veins, coronary arteries, and subclavian vein were unaffected. The presence of collapsed vessels was associated with a minor degree of cadaveric alteration. We observed that arteries and veins follow the same pattern of gas apparition for both the quantity and the location.In post-mortem radiology, collapsed vessels and intravascular gas are frequently visualized and as a result of all post-mortem changes, the assessment of the distribution of blood can be confusing. Therefore, knowledge of thanatological phenomena is crucial to prevent post-mortem radiological misapprehensions and possible false diagnoses.
Identifiants
pubmed: 37099083
doi: 10.1007/s00414-023-02999-y
pii: 10.1007/s00414-023-02999-y
pmc: PMC10247833
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1109-1115Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
Références
Brinkmann B, Madea B (2004) Handbuch gerichtliche Medizin. Springer, Berlin
doi: 10.1007/978-3-662-45345-2
Saukko P, Knight B (2004) Knight’s Forensic Pathology, 3rd edn. Hodder & Arnold, London
doi: 10.1201/b13642
Spitz WU, Fisher RS (2006) Medicolegal investigation of death: guidelines for the application of pathology to crime investigation. Thomas, 4th ed., Springfield
O’Donnell C, Woodford N (2008) Post-mortem radiology--a new sub-speciality? Clin Radiol 63(11):1189–1194
doi: 10.1016/j.crad.2008.05.008
pubmed: 18929036
Grabherr S, Lesta Mdel M, Rizzo E, Mangin P, Bollmann M (2008) Forensic imaging. Rev Med Suisse 4(164):1609–1614
pubmed: 18711974
Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P (2008) Virtual autopsy using imaging: bridging radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol 18(2):273–282
doi: 10.1007/s00330-007-0737-4
pubmed: 17705044
Paperno S, Riepert T, Krug B, Rothschild MA, Schultes A, Staak M, Lackner L (2005) Prospektive Untersuchung zur Wertigkeit der postmortalen Computertomographie im Vergleich zur Autopsie. Rofo 77(1):130–136
doi: 10.1055/s-2004-813735
Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26(5):1305–1333
doi: 10.1148/rg.265065001
pubmed: 16973767
Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R (2007) VIRTOPSY – the Swiss virtual autopsy approach. Leg Med (Tokyo) 9(2):100–104
doi: 10.1016/j.legalmed.2006.11.011
pubmed: 17275386
Grabherr S, Grimm J, Heinemann A (2016) Atlas of post-mortem angiography. Springer
doi: 10.1007/978-3-319-28537-5
Levy AD, Harcke HT, Mallak CT (2010) Post-mortem imaging: MDCT features of post-mortem change and decomposition. Am J Forensic Med Pathol 31(1):12–17
doi: 10.1097/PAF.0b013e3181c65e1a
pubmed: 20010292
Filograna L, Thali MJ (2017) Post-mortem CT imaging of the lungs: pathological versus non-pathological findings. Radiol Med 122(12):902–908
doi: 10.1007/s11547-017-0802-2
pubmed: 28836139
Jackowski C, Thali M, Aghayev E, Yen K, Sonnenschein M, Zwygart K, Dirnhofer R, Vock P (2006) Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med 120(4):233–240
doi: 10.1007/s00414-005-0023-4
pubmed: 16328426
Bruguier C, Mosimann PJ, Vaucher P, Uské A, Doenz F, Jackowski C, Mangin P, Grabherr S (2013) Multi-phase post-mortem CT angiography: recognizing technique-related artefacts and pitfalls. Int J Legal Med 127:639–652
doi: 10.1007/s00414-013-0840-9
pubmed: 23515679
Lennert K, Harms uD (1970) Über die Bedeutung flüssigen Leichenblutes in: an den Grenzen von Medizin und Recht, Festschrift für Prof. Dr. Wilhelm Hallermann, S. 134 – 139, Ferdinand Enke Verlag, Stuttgart, Jahrgang
O’Donnell C, Rotman A, Collett S, Woodford N (2007) Current status of routine post-mortem CT in Melbourne, Australia. Forensic Sci Med Pathol 3(3):226–232
doi: 10.1007/s12024-007-9006-8
pubmed: 25869169
Paperno S, Riepert T, Krug B, Rothschild MA, Schultes A, Staak M, Lackner L (2005) Value of postmortem computed tomography in comparison to autopsy. Rofo 177(1):130–136
doi: 10.1055/s-2004-813735
pubmed: 15657832
Payne-James J (2003) Forensic medicine: clinical and pathological aspects. Greenwich Medical Media, San Francisco
Aghayev E, Yen K, Sonnenschein M, Jackowski C, Thali M, Vock P, Dirnhofer R (2005) Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging? Forensic Sci Int 153(2-3):181–188
doi: 10.1016/j.forsciint.2004.09.124
pubmed: 16139108
Jackowski C, Thali M, Sonnenschein M, Aghayev E, Yen K, Dirnhofer R, Vock P (2004) Visualization and quantification of air embolism structure by processing postmortem MSCT data. J Forensic Sci 49(6):1339–1342
doi: 10.1520/JFS2004047
pubmed: 15568710
Shiotani S, Kohno M, Ohashi N, Atake S, Yamazaki K, Nakayama H (2005) Cardiovascular gas on non-traumatic postmortem computed tomography (PMCT): the influence of cardiopulmonary resuscitation. Radiat Med 23(4):225–229
pubmed: 16012397
Kauczor HU, Riepert T, Wolcke B, Lasczkowski G, Mildenberger P (1995) Fatal venous air embolism: proof and volumetry by helical CT. Eur Radiol 21:155–157
doi: 10.1016/0720-048X(95)00683-H
Egger C, Bize P, Vaucher P, Mosimann P, Schneider B, Dominguez A, Meuli R, Mangin P, Grabherr S (2012) Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT). Int J Legal Med 126:3–12
doi: 10.1007/s00414-010-0542-5
pubmed: 21207230
Egger C, Vaucher P, Doenz F, Palmiere C, Mangin P, Grabherr S (2012 Jul) Development and validation of a postmortem radiological alteration index: the RA-Index. Int J Legal Med 126(4):559–566
doi: 10.1007/s00414-012-0686-6
pubmed: 22402872
Aghayev E, Sonnenschein M, Jackowski C, Thali M, Buck U, Yen K, Bolliger S, Dirnhofer R, Vock P (2006) Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI. AJR Am J Roentgenol 187:209–215
doi: 10.2214/AJR.05.0222
pubmed: 16794178
Jeffrey RB Jr, Federle MP (1988) The collapsed inferior vena cava: CT evidence of hypovolemia. AJR Am J Roentgenol 150:431–432
doi: 10.2214/ajr.150.2.431
pubmed: 3257336
Eisenstat RS, Whitford AC, Lane MJ, Katz DS (2002) The “flat cava” sign revisited: what is its significance in patients without trauma? AJR Am J Roentgenol 178:21–25
doi: 10.2214/ajr.178.1.1780021
pubmed: 11756080
Thali MJ, Yen K, Schweitzer W, Vock P, Ozdoba C, Dirnhofer R (2003) Into the decomposed body-forensic digital autopsy using multislice-computed tomography. Forensic Sci Int 134(2-3):109–114
doi: 10.1016/S0379-0738(03)00137-3
pubmed: 12850403
Taylor GA, Fallat ME, Eichelberger MR (1987) Hypovolemic shock in children: abdominal CT manifestations. Radiology 164(2):479–481
doi: 10.1148/radiology.164.2.3602389
pubmed: 3602389
Sivit CJ, Taylor GA, Bulas DI, Kushner DC, Potter BM, Eichelberger MR (1992) Posttraumatic shock in children: CT findings associated with hemodynamic instability. Radiology 182(3):723–726
doi: 10.1148/radiology.182.3.1535886
pubmed: 1535886
Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N (2020) Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: a systematic review and meta-analysis. J Intensive Care Med 35(4):354–363
doi: 10.1177/0885066617752308
pubmed: 29343170
Costopoulos C, Liew TV, Bennett M (2008) Ageing and atherosclerosis: mechanisms and therapeutic options. Biochem Pharmacol 75(6):1251–1261
doi: 10.1016/j.bcp.2007.10.006
pubmed: 18035332
Tyrrell DJ, Goldstein DR (2021) Ageing and atherosclerosis: vascular intrinsic and extrinsic factors and potential role of IL-6. Nat Rev Cardiol 18(1):58–68
doi: 10.1038/s41569-020-0431-7
pubmed: 32918047
Wang JC, Bennett M (2012) Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res 111(2):245–259
doi: 10.1161/CIRCRESAHA.111.261388
pubmed: 22773427
Grabherr S, Heinemann A, Vogel H, Rutty G, Morgan B, Woźniak K, Dedouit F, Fischer F, Lochner S, Wittig H, Guglielmi G, Eplinius F, Michaud K, Palmiere C, Chevallier C, Mangin P, Grimm JM (2018) Postmortem CT angiography compared with autopsy: a forensic multicenter study. Radiology 288(1):270–276
doi: 10.1148/radiol.2018170559
pubmed: 29714682
Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R (2007) Postmortem angiography: review of former and current methods. AJR Am J Roentgenol 188(3):832–838
doi: 10.2214/AJR.06.0787
pubmed: 17312075
Grabherr S, Doenz F, Steger B, Dirnhofer R, Dominguez A, Sollberger B, Gygax E, Rizzo E, Chevallier C, Meuli R, Mangin P (2011) Multi-phase post-mortem CT angiography: development of a standardized protocol. Int J Legal Med 125(6):791–802
doi: 10.1007/s00414-010-0526-5
pubmed: 21057803
Coolen BF, Calcagno C, van Ooij P, Fayad ZA, Strijkers GJ, Nederveen AJ (2018) Vessel wall characterization using quantitative MRI: what’s in a number? MAGMA 31(1):201–222
doi: 10.1007/s10334-017-0644-x
pubmed: 28808823