Optimal pressure for mimicking clinical breath holding inspiratory CT in the deceased for VPMCT

Introduction Ventilated PMCT (VPMCT) has been reported to provide better quality of pulmonary structures in PMCT in adults and children. However, there are no consensus regarding optimal inflation pressure, and the practical use of VPMCT is still limited by cost of ventilation equipment. Here, we describe a simple and cost-efficient inflation-device for VPMCT and investigate optimal inflation pressure. Aim To elucidate the effect of different ventilation pressures on total lung volume and the volume of ground glass opacities (GGO), air-filled tissue, consolidations, and bronchi in VPMCT. Materials and method A precise inflation device was assembled using standard components: a back-pressure regulator, a water manometer and silicone tubing. Each case had PMCT performed at 0, 10, 20, 30 and 40 cmH2O pressure. Volumes were measured using stereology. Results 14 cases were enrolled in the study. The total lung volume increased significantly by 3612 mL (median) from 0 to 30 cmH2O (p = 0.001). The volume of consolidations was significantly reduced by 455.86 mL (median) between 0 and 30 cmH2O (p = 0.001). A significant reduction of GGO-volume of 133 mL (median) was observed at the pressure interval 30–40 cmH2O (p = 0.031), but not at lower pressures. Conclusion The constructed inflation device allowed precise and reproducible inflation of the lungs in deceased humans. We found a maximum effect of inflation at 30 cmH2O. At further inflation pressure, only the volume of GGOs decreased , but the effect was minor. For mimicking an in vivo breath-hold scan in PMCT we recommend inflation pressure of 30 cmH2O. + Graphical abstrac

Iatrogenic deaths: A 25-year retrospective study of medicolegal autopsies

Background: It is stipulated in the Danish Health Act that any death which could be caused by a mistake, neglect or accident in relation to treatment or prophylaxis should be reported to the police. It is then within the power of the police to request a medicolegal autopsy. Aim: To profile the possible iatrogenic deaths in relation to different characteristics

Identification of discrete vascular lesions in the extremities using post-mortem computed tomography angiography – Case reports

In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three cases suffering from vascular lesions in the upper extremities. In each subject, the third part of the axillary arteries and veins were used to catheterize the arms. The vessels were filled with a barium sulfate based contrast agent using a syringe. A CT scan was performed before and after filling of the vessels. Partial PMCTA provided information about the exact location and the severity of lesions. In one subject, partial PMCTA was essential to identify the cause of death. The substantial benefit of partial PMCTA is that the procedure is easily performed using standard clinically available CT systems without the use of pumps or other advanced equipment. These findings demonstrated the feasibility of PMCTA for identification of vascular lesions in the upper extremities. We expect that partial PMCTA can be of great value in cases where the subjects are suspected to have lesions in the extremities

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to the head and neck induced by a sudden braking event in a commonly experienced non-collision traffic incident. The likely mechanism of injury resulted from interaction between the occupant and the 3-point seat belt. These findings indicate that ICA dissections are substantially more likely to be associated with SAH following head and neck trauma, regardless of the magnitude of the traumatic event or whether an impact was involved