Utilizing PMCT Angiography In Augmenting The Role Of Virtual Autopsy In A Case Of Sudden Cardiac Death
DOI:
https://doi.org/10.48165/jfmt.2025.42.4.22Keywords:
Virtual autopsy, PMCTA, Postmortem angiography, Sudden cardiac death, Forensic radiologyAbstract
Sudden cardiac death (SCD) refers to the unexpected death of an individual occurring within one hour of symptom onset or within 24 hours of last being seen in good health if the death is unwitnessed. Since virtual autopsy is finding its way globally, the applications of postmortem computed tomography (PMCT) in cases of sudden cardiac death, which forensic pathologists frequently encounter, should be fostered and further developed. This case report discusses the sudden death of a 60-year-old male who had an acute on chronic infarct in the left ventricle and multiple foci of calcifications in the coronary arteries and the aorta. Though coronary and aortic calcifications were clearly visualised by PMCT, the critical patency of the lumen at the site of occlusion and the myocardial pathology could not be adequately visualised. PMCT angiography (PMCTA) was performed subsequently, which provided excellent visualisation of the luminal patency of coronary vessels, thereby augmenting the efficiency and diagnostic yield of virtual autopsy. Additionally, in resource-lim ited settings like India, where cost-effectiveness is a major factor, barium-based contrast agents have been tried in this case as an alternative to Iohexol (iodine-based agents), and the challenges faced in such scenarios are also comprehen sively discussed with a forward-looking perspective on future improvements.
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References
Fishman GI, Chugh SS, DiMarco JP, et al. Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society workshop. Circulation. 2010;122(22):2335–2348.
Thali MJ, Yen K, Schweitzer W, etal. Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)—a feasibility study. J Forensic Sci. 2003;48(2):386–403.
Schoenmackers J. Technic of postmortem angiography with reference to related methods of postmortem blood vessel demonstration. Ergeb Allg Pathol Pathol Anat. 1960;39:53–151.
Grabherr S, Djonov V, Yen K, Thali MJ, Dirnhofer R. Postmortem angiography: review of former and current methods. AJR Am J Roentgenol. 2007;188(3):832–838.
Thali MJ, Dirnhofer R, Vock P. The virtopsy approach: 3D optical and radiological scanning and reconstruction in forensic medicine. Boca Raton: CRC Press; 2009.
Turillazzi E, Frati P, Pascale N, Pomara C, Grilli G, Viola RV, Fineschi V. Multi-phase postmortem CT angiography: a pathologic correlation study on cardiovascular sudden death. J Geriatr Cardiol. 2016;13(10):855–865.
Rutty GN, Morgan B, Robinson C, et al. Diagnostic accuracy of postmortem CT with targeted coronary angiography versus autopsy for coroner-requested postmortem investigations: a prospective, masked, comparison study. Lancet. 2017;390(10090):145–154.
Kasahara S, Makino Y, Hayakawa M, Yajima D, Ito H, Iwase H. Diagnosable and non-diagnosable causes of death by postmortem computed tomography: a review of 339 forensic cases. Leg Med (Tokyo). 2012;14(5):239–245.
Rajiah P, Kanne JP. Computed tomography of the pericardium and pericardial disease. J Cardiovasc Comput Tomogr. 2010;4(1):3–18.
Sun JS, Park KJ, Kang DK. CT findings in patients with pericardial effusion: differentiation of malignant and benign disease. AJR Am J Roentgenol. 2010;194(6):W489–W494.
Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR imaging of pericardial disease. Radiographics. 2003;23(Suppl 1):S167–S180.
Gow RM. Myocardial bridging: does it cause sudden death? Card Electrophysiol Rev. 2002;6(1–2):112–114.
Lee MS, Chen CH. Myocardial bridging: an up-to-date review. J Invasive Cardiol. 2015;27(11):521–528.
Johnson KM, Johnson HE, Dowe DA. Left ventricular apical thinning as normal anatomy. J Comput Assist Tomogr. 2009;33(3):334–337.
Kajinami K, Seki H, Takekoshi N, Mabuchi H. Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results. J Am Coll Cardiol. 1995;26(5):1209–1221.
Savino G, Zwerner P, Herzog C, et al. CT of cardiac function. J Thorac Imaging. 2007;22(1):86–100.
Grabherr S, Hess A, Karolczak M, Thali MJ, Friess SD, Kalender WA, Dirnhofer R, Djonov V. Angiofil-mediated visualization of the vascular system by microcomputed tomography: a feasibility study. Microsc Res Tech. 2008;71(7):551–556.
