2.5. Evaluation of vascular diameter and cases of pulmonary embolism sudden death

Abstract

Objective Cases of fatal pulmonary embolism (PE) represent a diagnostic challenge to post-mortem imaging. The aim of this study was to investigate the relationship between the diameter of the inferior cava vein and cases of fatal pulmonary embolism on post-mortem CT (PMCT). Material and methods We retrospectively measured the diameter of the inferior cava vein (ICV) at the level of the superior mesenteric artery in 164 cases on PMCT (26 cases of confirmed pulmonary embolism, 24 age and sex matched cases of myocardial infarction (MI), and 114 randomized control cases (CC)) and investigated levels of significance between these groups and the diagnostic power of a cut-off value for the ICV. Results Mean ICV diameters were 7 mm (SD 8.1 mm) in the CC, 7 mm (SD 5.5 mm) in the MI, and 11 mm (SD 8.1 mm) in the PE group. Mann−Whitney U -Test revealed a significant difference in ICV diameters between PE and CC ( p =0.004) and between PE and both CC and MI together ( p =0.006), but not between MI and CC ( p =0.40), and between PE and MI (p=0.11). The receiver operating characteristics (ROC) curve revealed the optimal cut-off value: at 12.5 mm the diameter of the ICV features a specificity of 83% and a sensitivity of 54% to indicate the presence of pulmonary embolism. Conclusion This study revealed that increased diameter of the inferior cava vein is an indicator of pulmonary embolism on PMCT. However, this radiologic sign has a poor prognostic value and further research is needed to reliably distinguish between cases of PE and MI.