Assessment of Myocardial Ischemia Using Coronary Postmortem Computed Tomography Angiography Based on the Voronoi Algorithm: A Case Report.

Postmortem computed tomography angiography (PMCTA) is a valuable tool for diagnosing vascular conditions, such as hemorrhages, in trauma cases. This case report demonstrates the use of the Voronoi algorithm to assess myocardial ischemia using coronary PMCTA. A male in his 70s was found unconscious in a car after colliding with a traffic light pole. Despite medical interventions, including pericardial drainage and cardiopulmonary resuscitation, the patient died two hours later. PMCTA revealed significant filling defects in the left anterior descending artery (LAD), consistent with plaque rupture and narrowing observed during autopsy. The cause of death in this case was likely cardiac tamponade due to cardiac rupture secondary to myocardial infarction resulting from LAD stenosis. Cardiac perfusion areas were analyzed using the Voronoi algorithm, demonstrating a total myocardial volume of 151.9 mL in the left ventricle. Perfusion volumes were calculated as 92.9 mL (61.2%) for the LAD, 34.2 mL (22.5%) for the left circumflex artery, and 24.9 mL (16.4%) for the right coronary artery. The predicted ischemic volume distal to the LAD stenosis was estimated to be 49.8 mL (32.8%). Furthermore, the ischemic areas observed during autopsy macroscopically corresponded well with the predicted ischemic regions. This case highlights that combining PMCTA with the Voronoi algorithm provides an accurate method for assessing myocardial ischemic areas, offering a non-invasive approach to visualize and quantify perfusion and ischemic regions.

Visualization of left common carotid artery injury by glass using postmortem virtual angioscopy.

A deceased man in his 50 s was found with his neck over a broken glass door frame, with blood around the body. A non-contrast postmortem computed tomography (PMCT) scan revealed subcutaneous hemorrhage, temporal bone fracture, and cerebral contusion. Also, wounds extending from the anterior to posterior neck and the presence of air in the cervical vessels suggested cervical vascular injury. A virtual angioscopy image reconstructed from PMCT angiography data revealed a ruptured left common carotid artery and allowed accurate measurement of the injury. This case demonstrates the effectiveness of postmortem virtual angioscopy for visualization and evaluation of vascular injuries, providing valuable insights for forensic investigation.