Multiphase post-mortem computed tomography angiography in seven lethal cases of great height falls: Preliminary results of a French experience

Abstract

Background The use of enhanced multislice computed tomography (MSCT) in forensic sciences has been recently developed in order to improve radiological vascular and organs injuries detection. Methods Seven suicidal cases of great height falls (4 women, and 3 men) underwent a multiphase post-mortem computed tomography angiography (MPMCTA) before medico-legal autopsy. The estimated height falls varied from 5 to 15 m. All corpses were prepared with a surgical cannulation of femoral vessels. After a non-MSCT exploration, a controlled perfusion device (Virtangio ® machine) was used with paraffin oil mixed with specific contrast agent (Angiofil ® ), allowing three time-different acquisitions (arterial, venous, dynamic). Two radiologists proceeded to images analysis. The forensic pathologist undergoing autopsies knew preliminary imaging results. Results The results of MPMCTA explorations and autopsies differed concerning detection of gas, bone fractures, and vascular ruptures (mainly cerebral), with a superiority of the MPMCTA. Autopsies were superior to MPMCTA for detection of some superficial skin lesions, which were easily accessible to external examination. Discussion Both techniques were able to diagnose some classical and typical bone, visceral and vascular lesions. Additionally, some rare injuries were found like coronary desinsertion, double thoracic aortic ruptures, inferior vena cava laceration extended to the right atrium, and pulmonary vein disruption. These findings were found with both techniques, but MPMCTA permitted better in situ lesions' illustration and documentation. Furthermore, realization of different-time acquisitions was essential for detection and comprehension of abnormal traumatic communication between cardiac cavities. Conclusion This study illustrates the complementarity of MPMCTA and autopsy in traumatic cases, and especially for cases of lethal great height falls.