Noriki Sakon, Kinoshita Kazuyuki, Inai Kunihiro, Sakai Toyohiko, Kimura Hirohiko, Yamauchi Takahiro, Iwano Masayuki, Naiki Hironobu
Division of Tumor Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Eiheiji-cho, Yoshida-gun, 910-1193, Fukui, Japan.
Autopsy Imaging Center, School of Medical Sciences, University of Fukui, Fukui, Japan.
BMC Med Imaging. 2017 Jan 10;17(1):4. doi: 10.1186/s12880-016-0174-4.
Postmortem imaging (PMI) refers to the imaging of cadavers by computed tomography (CT) and/or magnetic resonance imaging (MRI). Three cases of cerebral infarctions that were not found during life but were newly recognized on PMI and were associated with severe systemic infections are presented.
An 81-year-old woman with a pacemaker and slightly impaired liver function presented with fever. Imaging suggested interstitial pneumonia and an iliopsoas abscess, and blood tests showed liver dysfunction and disseminated intravascular coagulation (DIC). Despite three-agent combined therapy for tuberculosis, she died 32 days after hospitalization. PMI showed multiple fresh cerebral and cerebellar infarctions and diffuse ground-glass shadows in bilateral lungs. On autopsy, the diagnosis of miliary tuberculosis was made, and non-bacterial thrombotic endocarditis that involved the aortic valve may have caused the cerebral infarctions. A 74-year-old man on steroid therapy for systemic lupus erythematosus presented with severe anemia, melena with no obvious source, and DIC. Imaging suggested intestinal perforation. The patient was treated with antibiotics and drainage of ascites. However, he developed adult respiratory distress syndrome, worsening DIC, and renal dysfunction and died 2 months after admission. PMI showed infiltrative lung shadow, ascites, an abdominal aortic aneurysm, a wide infarction in the right parietal lobe, and multiple new cerebral infarctions. Autopsy examination showed purulent ascites, diffuse peritonitis, invasive bronchopulmonary aspergillosis, and non-bacterial thrombotic endocarditis that likely caused the cerebral infarctions. A 65-year-old man with an old pontine infarction presented with a fever and neutropenia. Despite appropriate treatment, his fever persisted. CT showed bilateral upper lobe pneumonia, pain appeared in both femoral regions, and intramuscular abscesses of both shoulders developed. His pneumonia worsened, his level of consciousness decreased, right hemiplegia developed, and he died. PMI showed a newly diagnosed cerebral infarction in the left parietal lobe. The autopsy revealed bilateral bronchopneumonia, right-sided pleuritis with effusion, an intramuscular abscess in the right thigh, and fresh multiple organ infarctions. Systemic fibrin thrombosis and DIC were also found. Postmortem cultures showed E. coli and Burkholderia cepacia.
Cerebral infarction that is newly recognized on PMI might suggest the presence of severe systemic infection.
尸检成像（PMI）是指通过计算机断层扫描（CT）和/或磁共振成像（MRI）对尸体进行成像。本文报告了3例生前未发现但在尸检成像时新发现且与严重全身感染相关的脑梗死病例。
一名81岁女性，有起搏器且肝功能轻度受损，出现发热症状。影像学检查提示间质性肺炎和髂腰肌脓肿，血液检查显示肝功能障碍和弥散性血管内凝血（DIC）。尽管采用三联抗结核治疗，她在住院32天后死亡。尸检成像显示多发性新鲜脑和小脑梗死以及双侧肺部弥漫性磨玻璃影。尸检诊断为粟粒性肺结核，累及主动脉瓣的非细菌性血栓性心内膜炎可能导致了脑梗死。一名74岁男性，因系统性红斑狼疮接受类固醇治疗，出现严重贫血、不明原因的黑便和DIC。影像学检查提示肠穿孔。患者接受了抗生素治疗和腹水引流。然而，他发展为成人呼吸窘迫综合征、DIC恶化和肾功能障碍，并在入院2个月后死亡。尸检成像显示肺部浸润影、腹水、腹主动脉瘤、右顶叶广泛梗死和多发性新的脑梗死。尸检显示脓性腹水、弥漫性腹膜炎、侵袭性支气管肺曲霉病以及可能导致脑梗死的非细菌性血栓性心内膜炎。一名65岁男性，有陈旧性脑桥梗死，出现发热和中性粒细胞减少。尽管进行了适当治疗，他的发热仍持续。CT显示双侧上叶肺炎，双侧股骨区域出现疼痛，双肩出现肌内脓肿。他的肺炎恶化，意识水平下降，出现右侧偏瘫，随后死亡。尸检成像显示左顶叶新诊断的脑梗死。尸检发现双侧支气管肺炎、右侧胸腔积液性胸膜炎以及右大腿肌内脓肿和新鲜的多器官梗死。还发现了全身性纤维蛋白血栓形成和DIC。尸检培养显示大肠杆菌和洋葱伯克霍尔德菌。
尸检成像时新发现的脑梗死可能提示存在严重的全身感染。
