Postmortem Imaging Center Zürich, Institute of Legal Medicine, University of Zürich, Zürich, Switzerland.
Forensic Sci Int. 2012 Jan 10;214(1-3):e16-9. doi: 10.1016/j.forsciint.2011.07.010. Epub 2011 Jul 28.
Sudden cardiac deaths are common within the community. They also constitute a substantial part of daily pathologic and forensic case work. However, macroscopic myocardial findings indicating acute ischemia are often absent. Then, diagnosis is based on coronary status in combination with indirect signs of acute cardiac failure. We present a case of sudden cardiac death where diagnosis was based on cardiac postmortem magnetic resonance imaging (pmMRI) findings already prior to autopsy: the heart's anterior basal ventricular septum showed hypointensities in T2-weighted images that raised suspicion of peracute ischemia. The lumen of the left anterior descending artery (LAD) exhibited a lack of otherwise discernible postmortem sedimentation of cellular blood components. Instead of a sharp border between serum and erythrocytes a homogeneous signal was seen within the narrowed lumen of the beginning LAD over a length of 1cm. Based on this, a thrombotic occlusion was assumed. Subsequent autopsy confirmed peracute septal myocardial ischemia secondary to a thrombotic occlusion of the LAD as concluded from the pmMRI.
心脏性猝死在社区中很常见。它们也是日常病理和法医工作的重要组成部分。然而，通常不存在表明急性缺血的宏观心肌发现。然后，诊断基于冠状动脉状态结合急性心力衰竭的间接迹象。我们提出了一个心脏性猝死的病例，其中诊断是基于心脏死后磁共振成像 (pmMRI) 的发现，甚至在尸检之前：心脏前基底室间隔在 T2 加权图像上显示低信号，提示急性缺血。左前降支 (LAD) 的管腔显示出缺乏其他可识别的死后细胞血液成分的沉淀。在开始 LAD 的狭窄管腔中，在 1cm 的长度内，可见到均匀的信号，而不是血清和红细胞之间的锐利边界。基于此，假设为血栓闭塞。随后的尸检证实了前壁间隔心肌的急性缺血，这是由 pmMRI 推断出的 LAD 的血栓闭塞引起的。
