Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis.

Details

Serval ID
serval:BIB_4A4905582918
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis.
Journal
Forensic Science International
Author(s)
Capuani C., Guilbeau-Frugier C., Mokrane F.Z., Delisle M.B., Marcheix B., Rousseau H., Telmon N., Rougé D., Dedouit F.
ISSN
1872-6283 (Electronic)
ISSN-L
0379-0738
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
242
Pages
e12-e17
Language
english
Notes
Publication types: Case Reports ; Journal ArticlePublication Status: ppublish
Abstract
A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.
Keywords
Adult, Angiography, Artifacts, Contrast Media, Humans, Lung/pathology, Male, Middle Cerebral Artery/radiography, Multidetector Computed Tomography, Pleural Effusion/radiography, Pulmonary Alveoli/pathology, Respiratory Insufficiency/etiology, Systemic Vasculitis/diagnosis, Temporal Arteries/radiography
Pubmed
Web of science
Create date
12/01/2016 11:52
Last modification date
20/08/2019 13:57
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