Filograna Laura, Laberke Patrick, Ampanozi Garyfalia, Schweitzer Wolf, Thali Michael J, Bonomo Lorenzo
Department of Radiological Sciences, Catholic University of Rome, School of Medicine, University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy,
Radiol Med. 2015 Aug;120(8):723-30. doi: 10.1007/s11547-015-0517-1. Epub 2015 Feb 19.
When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT.
We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding.
Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases).
PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.
当在尸检时发现心包积血（HP）时，对于法医病理学家而言，评估其在死因中的作用是一项挑战。事实上，心包填塞（PT）的准确诊断必须基于临床和仪器检查数据，而这些数据在尸检调查中往往难以获取。本研究的目的是确定有助于诊断PT的尸检（PMCT）结果。
我们查阅了14例致命性HP且心包完整病例的PMCT图像和尸检报告。从尸检报告中，我们获取了HP的量和病因。对PMCT图像进行复查，以描述HP的表现以及心包内压力升高的间接征象。选择了11例在尸检前接受PMCT检查的对照组病例，其标准如下：无相关心包积液、静脉系统淤血和出血。
在14例PT患者中，13例HP呈双同心分层，冠状窦和/或肺动脉主干受压，均显示心脏前表面变平；还不同程度地观察到其他提示静脉系统淤血的表现。在对照组中，除上腔静脉扩张或未完全塌陷（11/11例）外，未发现这些表现。
PMCT能够提供一些提示PT的结果。基于这一证据，在其他情况下，HP可能被判定为间接死因而非致命原因。本研究表明利用PMCT结果回顾性证明临床情况（如PT）的可能性。
