Differentiation of ante-mortem and post-mortem fractures with MRI: a case report

We describe a case of a fatal speed flying accident in which the victim was electrocuted, burned and fell from a great height. Post-mortem imaging revealed acute appearing fractures on CT, without bone marrow oedema on MRI. Based on the known clinical imaging findings of bone marrow oedema in acute fractures, we concluded that the speed flyer died from electrocution rather than the fall and that the fractures occurred post-mortem. Radiological imaging augmented the reconstruction of the peri-mortem events. Further research is needed to assess whether bone marrow oedema in acute fractures is a reliable vital sign.     

Striking increases in postmortem compared to antemortem drug concentrations in a suicidal overdose: A case report

Toxicology testing revealed dramatic increases in whole-blood concentrations of verapamil and diphenhydramine in the short time between hospital admission and death (53 min) in a subject (with a history of overdosing) found unresponsive. While some degree of post-mortem redistribution (PMR) would be expected for the drugs found in this case, PMR cannot explain the considerable increases observed. It is recommended that in potential overdose cases without a clear manner of death but for which ante-mortem and post-mortem specimens (including gastric content) are available, all should be analysed and considered in order to make a more definitive conclusion regarding that death.     

Right atrial clot and pulmonary embolism in a patient with COVID-19: A case report

The infection caused by the novel coronavirus (COVID-19) immersed the globe into a widespread pandemic. The disease leads to acute respiratory disease syndrome , hypercoagulation, and cardio-vascular diseases. In this case report, we presented an 80-year-old man with right atrial clot and acute pulmonary embolism, who was diagnosed with COVID-19. The patient was isolated and transferred to the intensive care unit with a diagnosis of submissive pulmonary thromboembolism and right atrial clot following COVID-19 infection. Antibiotics and anticoagulants were administered, and the patient was referred for mechanical thrombectomy. He did not die and after recovery, was discharged with warfarin administration.Preventing thromboembolic events seems to be the first priority in the management of COVID-19 patients. It is necessary to look for strategies to manage and prevent the early occurrence of thromboembolic events in these patients.     

Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI

Objectives

To investigate unenhanced postmortem 3-T MR imaging (pmMRI) for the detection of pulmonary thrombembolism (PTE) as cause of death.

Methods

In eight forensic cases dying from a possible cardiac cause but with homogeneous myocardium at cardiac pmMRI, additional T2w imaging of the pulmonary artery was performed before forensic autopsy. Imaging was carried out on a 3-T MR system in the axial and main pulmonary artery adapted oblique orientation in situ. In three cases axial T2w pmMRI of the lower legs was added. Validation of imaging findings was performed during forensic autopsy.

Results

All eight cases showed homogeneous material of intermediate signal intensity within the main pulmonary artery and/or pulmonary artery branches. Autopsy confirmed the MR findings as pulmonary artery thrombembolism. At lower leg imaging unilateral dilated veins and subcutaneous oedema with or without homogeneous material of intermediate signal intensity within the popliteal vein were found.

Conclusions

Unenhanced pmMRI demonstrates pulmonary thrombembolism in situ. PmMR may serve as an alternative to clinical autopsy, especially when consent cannot be obtained.

Key Points

? Postmortem MRI (pmMRI) provides an alternative to clinical autopsy ? Fatal pulmonary thrombembolism (PTE) can now be diagnosed using postmortem MRI (pmMRI). ? Special attention has to be drawn to the differentiation of postmortem clots.     

Neurotrichinosis: a case report with MRI evaluation

Neurological complications are rare in trichinosis. A case of trichinosis involving the central nervous system documented by MRI is presented. To our knowledge, only three cases of neurotrichinosis with MRI abnormalities have been already reported. The physiopathological mechanism are discussed (transport of the parasite through the blood-stream, immuno-allergic reaction or eosinophilic neurotoxic effect).     

Sudden death during worker transportation due to massive pulmonary thromboembolism: a case report

This is a report on a 30-year-old black man who suddenly died in the worker transportation vehicle in which he had been quietly sitting for thirty minutes. No information about his medical or surgical history or any family history has been obtained. This case is intended to highlight the fact that forensic autopsy is a valuable tool to recognize the cause of death and that fatal pulmonary thromboembolism still remains a post-mortem diagnosis. In this case report, the autopsy found a fresh saddle pulmonary thromboembolus associated with partially organized thrombi of the inferior vena cava. Can a prolonged seated position encourage thrombus formation? We think that seat-related factors and especially patient-related factors intervene together in the development of thromboembolic events. In our medico-legal unit, having no means to search for these factors, we speculated on the various causes that could be involved in the occurrence of venous thromboembolism in our subject. We emphasize the importance of focusing research on genetic factors and the impact of traditional medicine in African people.     

Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report

International Journal of Legal Medicine - Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or...     

3. Sudden death due to pulmonary thromboembolism after car driving: a case report

An autopsy case of sudden death due to pulmonary thromboembolism after a car trip is reported. A 56-year-old Japanese man with hypertension and atrial fibrillation suddenly died immediately after having driven for two and a half hours. At autopsy, the pulmonary arteries were found to be filled with dark-red, coiling thrombi consisting of fibrin and red blood cells. In the dilated right popliteal vein, a thrombus consisting of fibroblasts, a large number of collagen fibres, and newly formed capillaries was attached to the vessel wall. The cause of death was determined to be pulmonary embolism due to the thrombus of the right popliteal vein. Two and a half hours of prolonged sitting while driving a car encouraged thrombus formation. We believe that this case, the first autopsy case of fatal pulmonary thromboembolism after a car trip to be reported, highlights the importance of predicting venous thrombosis of the leg or fatal venous thromboembolism after a car trip.     

MRI对肺动脉栓塞血液动力学评价的初步研究

目的 探讨MRI评价急性大面积肺动脉栓塞(简称肺栓塞)肺动脉血液动力学改变及肺动脉压力的价值.方法 21例经对比剂增强MR肺动脉造影(CE-MRPA)诊断的急性大面积肺栓塞患者和20名健康志愿者,获得MR血流编码肺动脉血流图像,测量主肺动脉直径、右肺动脉直径、主肺动脉血流峰值流速、平均流速、流量、反流在主肺动脉短轴平面的位置以及收缩期射血加速时间等血液动力学参数,比较肺栓塞患者与健康志愿者间肺动脉血液动力学参数的差异,并与右心导管检查对比,分析各血液动力学参数与肺动脉平均压的相关性.结果 急性大面积肺栓塞患者组与健康志愿者组的主肺动脉直径(分别为2.93、2.52 cm)、右肺动脉直径(分别为2.49、1.92 cm)差异有非常显著性意义(t值分别为3.55、4.19,P值均<0.01);患者组和健康志愿者组主肺动脉峰值流速(分别为85.29、100.63 cm/s)、平均流速(分别为11.00、17.12 cm/s)、流量(分别为89.15、98.96 ml/s)、收缩期射血加速时间(分别为105.09、163.85 ms)比较差异有非常显著性意义(t值分别为2.89、6.37、2.21、9.46,P值分别为0.01、<0.01、0.03、<0.01);急性大面积肺栓塞患者MR血流编码的肺动脉峰值流速-时间曲线表现为收缩期峰值流速降低且时间提前,并可见明显反流,肺动脉平均压力与主肺动脉直径(r=0.62, P=0.001)、右肺动脉直径(r=0.63, P=0.01)、射血加速时间(r=-0.55, P=0.005)3个参数有较强相关性.结论 MRI可直接显示肺动脉腔内血栓栓子,诊断急性大面积肺栓塞,并可测量肺动脉血液动力学参数变化,估计肺动脉高压程度,有望成为一种研究肺栓塞的无创性影像方法.     

药物流产后宫腔巨大血块1例

患者女,25岁。10天前宫内早孕(7周)行药物流产,服药后阴道间断性出血,本院B超检查显示:子宫稍大,宫下段宫腔内探及4·9cm×5·0cm×8·3cm大之不均质强回声,边界较清(图1),彩超下检测病灶区未见明显血流信号,双附件区未见特殊。超声诊断:考虑药物流产后宫腔内巨大血块。妇科查体显示血块堵住宫口,行清宫术,清出物均为血块。复查B超宫腔内异常回声消失。讨论:药物流产后出血较多,超声扫查发现宫腔积血或宫腔少量血块较常见,但药物流产后宫腔内存留如此巨大血块尚属少见。宫内形成巨大血块的原因尚不能十分确定,初步考虑可能是宫缩乏力造成血…     

Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography

The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as “aortic dissection”, “myocardial wall rupture” or “undetermined”. Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.     

肺多发结节18F-FDG PET/CT鉴别诊断一例

患者女,41岁,主诉检查发现双肺多发结节2个月余。患者2个月前外伤后出现意识障碍,当地医院胸部CT提示双肺多发大小不等结节,边界清楚,增强后未见明显强化。就诊于本院后查血清肿瘤标志物均正常。既往史:患者13年前行子宫肌瘤瘤体摘除术,11年前因子宫肌瘤复发行子宫切除术;8年前行左上臂脂肪瘤切除术;2个月前外伤后致右侧锁骨骨折。     

Right atrial angiosarcoma and MRI: a case report

The authors report a case of right atrial angiosarcoma in a 29 year old man presenting with massive pericardial effusion. This case illustrates the value of MRI in the preoperative evaluation, providing accurate information about the site and extension of the tumor, and even about the malignant nature of the lesion. Multiplanar transesophageal echocardiography did not provide any additional information in this case.     

腹膜后占位生长抑素受体显像鉴别诊断一例

患者女,41岁,主诉腰部不适1个月,无发热、头痛、恶心、呕吐、腹痛、腹胀、腹泻、头晕、黑矇、大汗等症状。腹部CT发现右侧腹膜后软组织密度肿块;增强CT+三维重建图像示肿块大小约57 mm×40 mm,增强后明显强化,各期强化程度与血管相似,肿块局部与十二指肠分界欠清,下腔静脉呈受压性改变(图1)。     

Renal and pulmonary lymphangioleiomyomatosis: a case report

Lymphangioleiomyomatosis (LAM) is a rare disease that most commonly involves the lung. However, extrapulmonary lymphangioleiomyomatosis rarely occurs with or without subsequent involvement of the lung. We report a case of incidentally found renal and pulmonary lymphangioleiomyomatosis in a patient who had no stigmata of tuberous sclerosis.     

肺血栓栓塞症MRI诊断初探

肺血检栓塞症(pulmonary thromboembolism,PTE)目前在老年人中，已被临床高度重视。其发病率高，病死率亦高，过去曾以为是少见病，临床上漏诊误诊情况严。为促进国内医学界对PIE的规范诊断和治疗，中华医学会呼吸病学分会于2001年5月制定了国内第一部肺血检栓塞症的诊断与治疗指南草案。肺血栓栓塞症的诊治得以规范。其诊断主要依     

肺原发性骨肉瘤一例

本文报道肺原发性骨肉瘤1例。患者男,77岁,CT表现为左肺下叶团块状软组织密度影,密度不均,内见多发囊状低密度影及点片状致密影,增强扫描实性部分呈不均匀明显强化,囊性部分未见强化。病理诊断:肺原发性骨肉瘤。     

原发性丛状肺动脉病一例

患者男,52岁,感冒后干咳1周,无发热、盗汗.体检:两侧胸廓对称,胸壁末触及肿块及结节.胸部听诊:呼吸音清晰,未闻及f湿I罗音,心律齐,心率约80次/min,腹部、四肢未见异常.既往高血压病史,血压170/110 mm Hg (1 mm Hg=0.133 kPa).实验室检查:凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)均在正常范围,肿瘤标志物如肿瘤特异性生长因子(TSGF)、癌胚抗原(CEA)及鳞状细胞癌抗原等均在正常范围内.