Berger Nicole, Martinez Rosita, Winklhofer Sebastian, Flach Patricia M, Ross Steffen, Ampanozi Garyfalia, Gascho Dominic, Thali Michael J, Ruder Thomas D
Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Leg Med (Tokyo). 2013 Nov;15(6):315-7. doi: 10.1016/j.legalmed.2013.07.001. Epub 2013 Aug 3.
We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.
我们报告了一例多期尸检计算机断层血管造影（PMCTA）在血管造影静脉期诱发出血性心包积液的病例。尸检非增强CT（PMCT）提示存在主动脉夹层破裂。在压力控制下动脉注射造影剂后，PMCTA证实了这一诊断。在多期PMCTA的第二阶段，注意到有造影剂从下腔静脉漏入心包腔。尸检证实了这种血管撕裂的死后性质。这个病例给我们上了重要的一课：它强调了批判性分析PMCT和PMCTA图像以区分伪影、真正的病理改变和医源性发现的必要性。在像本文报道的这种结果不明确的病例中，将影像学结果与尸检结果相关联至关重要。
