Korean J Radiol.  2015 Oct;16(5):1024-1028. 10.3348/kjr.2015.16.5.1024.

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

• KMID: 2160769
• DOI: http://doi.org/10.3348/kjr.2015.16.5.1024

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.

Keyword

Post-mortem radiology; CT angiography; Coronary thrombosis; Myocardial perfusion

MeSH Terms

*Autopsy
Coronary Occlusion/*diagnosis/etiology/radiography
Coronary Vessels/pathology/radiography
Female
Humans
Middle Aged
Myocardial Infarction/etiology/pathology
Myocardium
Thrombosis/complications/*diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 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

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