2.8. Post-mortem CT (PMCT) imaging findings of pericardial tamponade due to hemopericardium

Abstract

Objectives Hemopericardium (HP) is occasionally found at autopsy, but it represents a challenge for the forensic pathologist when having to assess its pathophysiological role in causing death, particularly in those cases where ante-mortem clinical and instrumental data are not available. The aim of this study was to individuate PMCT findings indicative for the diagnosis of pericardial tamponade (PT). Materials and methods We retrospectively 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, 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. Results 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 showed a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably detected. In the control group none of these findings was identified, with the exception of a distended superior vena cava equalling the ascending aorta (8/11 cases). Conclusions 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 an in vivo dynamic condition, such as PT.