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Massive Systemic Fat Embolism Detected by Postmortem Imaging and Biopsy

Authors

  • Patricia M. Flach M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
    2. Department of Neuroradiology, Inselspital Bern, University of Bern, 3010 Bern, Switzerland.
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  • Steffen G. Ross M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Stephan A. Bolliger M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Garyfalia Ampanozi M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Gary M. Hatch M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Corinna Schön M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Michael J. Thali M.D.,

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Tanja Germerott M.D.

    1. Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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  • Presented at the 63rd Annual Meeting of the American Academy of Forensic Sciences, February 21–26, in Chicago, IL.

Additional information and reprint requests:
Patricia M. Flach, M.D.
Centre for Forensic Imaging and Virtopsy
Institute of Forensic Medicine
University of Bern
Buehlstrasse 20
3012 Bern
Switzerland
E-mail: patricia.flach@irm.uzh.ch

Abstract

Abstract:  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.

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