Massive Systemic Fat Embolism Detected by Postmortem Imaging and Biopsy

:  Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image‐guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE)...

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Bibliographic Details
Published in:Journal of forensic sciences 2012-09, Vol.57 (5), p.1376-1380
Main Authors: Flach, Patricia M., Ross, Steffen G., Bolliger, Stephan A., Ampanozi, Garyfalia, Hatch, Gary M., Schön, Corinna, Thali, Michael J., Germerott, Tanja
Format: Article
Language:English
Subjects:
Accidental Falls
Aged, 80 and over
Angiography
Autopsies
Autopsy - methods
Biopsy
Blood clots
computed tomography
Embolism, Fat - diagnosis
Embolisms
fat embolism
Female
Femoral Neck Fractures - etiology
Forensic pathology
forensic science
Heart Failure - etiology
Histology
Humans
Image-Guided Biopsy
Medical imaging
postmortem computed tomography angiography
postmortem imaging
systemic fat embolism
Tomography, X-Ray Computed
virtopsy
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Summary::  Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image‐guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole‐body unenhanced pmCT, pmCTA, and image‐guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image‐guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image‐guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image‐guided biopsy, may detect the cause of death prior to traditional autopsy.
ISSN:0022-1198
1556-4029
DOI:10.1111/j.1556-4029.2012.02144.x