Right-sided acute infective endocarditis with septic pulmonary embolism; postmortem computed tomography and forensic autopsy findings. A case report

Abstract

• Postmortem CT (PMCT) of a female intravenous drug user was performed. • PMCT showed multiple pulmonary infiltrates and pleural fluid. • Autopsy showed acute infective endocarditis of the tricuspid valve. • Histopathology revealed septic pulmonary embolisms. • PMCT is an important complimentary examination to autopsy. Infective endocarditis of the tricuspid valve is a known complication to intravenous drug use (IDU) and can lead to septic pulmonary embolism. This can be difficult to detect at a standard autopsy. The use of postmortem computed tomography (PMCT) is increasingly used as an important supplement to forensic autopsy. We herein present a case in which the PMCT of a 40-year-old woman with intravenous drug use (IDU) revealed multiple pulmonary infiltrates, which at the subsequent autopsy was shown to be septic pulmonary embolisms as a result of acute infective endocarditis of the tricuspid valve cusps. The endocarditis was macroscopically visible at autopsy, but the pulmonary embolisms were not. The PMCT images showed bipulmonary multiple scattered infiltrates, which were sampled and shown microscopically to be septic pulmonary embolisms. Using PMCT in this case allowed for a more targeted autopsy, and more accurate diagnosis and conclusions as to cause of death. This confirms the important role of PMCT as a complimentary examination method to autopsy.