Diagnosis of coronary artery disease using targeted post-mortem computed tomography coronary angiography: a case report

Abstract

Targeted post-mortem computed tomography (PMCT) combined with coronary angiography has the potential to play a significant role in the investigation of sudden cardiac death. The authors utilized a targeted PMCT coronary angiography in a case involving a 53-year-old man who died from acute myocardial ischemia and cardiac decompensation which may result from coronary artery disease (CAD). The victim collapsed suddenly at work and died soon after arrival to hospital. The body was examined using PMCT and targeted PMCT coronary angiography. The left anterior descending coronary artery exhibited 75%-100% stenosis in the middle segment; however, the distal segment could not be clearly visualized. In addition, the left circumflex and right coronary artery exhibited calcification, atherosclerosis and an area of 50% stenosis. Signs of cardiogenic pulmonary oedema were also identified. The imaging results suggested that this individual had coronary atherosclerosis and probably died from CAD. The autopsy and histological examination revealed acute myocardial ischemia and myocardial scarring, confirming the cause of death while excluding other probabilities. In summary, targeted post-mortem computed tomography angiography (PMCTA) can visualize the arteries and estimate the degree of principal pathological changes. This method is a simple, reliable and sensitive technique for identifying the presence of coronary atherosclerosis. It is a valuable post-mortem forensic imaging method and should be recommended in the investigation of suspicious cardiac deaths.

Keywords: Forensic science; PMCT; PMCTA; coronary atherosclerosis; forensic pathology; post-mortem forensic imaging; targeted coronary angiography.

Figure 1.

(A) Volume-rendered contrast-enhanced image revealing contrast medium filling the aortic root and the LAD. The LAD had 75%–100% stenosis in the middle segment; however, the distal segment could not be clearly visualized (arrow). (B) Histological examination confirming 75%–100% stenosis in the middle segment of the LAD. (H&E ×20).

Figure 2.

(A) Curved multiplanar reconstruction image revealing calcification and atherosclerosis of RCA, with several localized area exhibiting 50% stenosis (arrows). RCA is marked and appears in black for it is filled with gas. (B) Histological examination confirming 50% stenosis in the RCA. (H&E ×20).

Figure 3.

(A) Autopsy revealed myocardial fibrosis in the posterior wall of the left ventricle (arrows). Histological examination of samples in H&E staining revealed (B) enhanced eosinophilic staining and fractures of cardiomyocytes (×40), (C) myocardial scarring (×20) and (D) multiple dissolution of cardiomyocytes (arrows) (×100).