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International Journal of Legal Medicine
Published in: International Journal of Legal Medicine 6/2019

01-11-2019 | Computed Tomography | Original Article

Approaching pulmonary fat embolism on postmortem computed tomography

Authors: Vasiliki Chatzaraki, Jakob Heimer, Michael J. Thali, Garyfalia Ampanozi, Wolf Schweitzer

Published in: International Journal of Legal Medicine | Issue 6/2019

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Abstract

Purpose

Pulmonary fat embolism (PFE) is a relevant diagnosis playing a role as a sign of vitality or a cause of death. Its severity is assessed according to histological grading systems like that of Falzi. The aim of this study was to determine the utility of unenhanced postmortem computed tomography (PMCT) for PFE diagnosis based on the detection of fat layers.

Methods

Consecutive cases with PMCT and autopsy were studied retrospectively. The case group consisted of cases with positive PFE, and the control group included cases with negative PFE. Three observers independently assessed PMCT data for fat layers in the pulmonary trunk and the right and left pulmonary artery. For cases with fat layers, autopsy protocols were assessed for the cause of death, relation to trauma, and undertaken resuscitation measures.

Results

Eight hundred thirty cases were included: 366 PFE positive cases (144 of Falzi grade 1, 63 of 1.5, 99 of 2, 28 of 2.5, and 32 of 3) and 464 PFE negative cases. Interrater reliabilities varied between substantial and almost perfect, and discrepancies were solved according to majority. Eighteen cases showed fat layers on PMCT (2 controls—traumatic instantaneous deaths—, 16 PFE positive cases). PMCT showed low sensitivity but high specificity for PFE diagnosis. The layers were located at the same position in the pulmonary trunk directly adjacent to the pulmonary valve distal to the right ventricle.

Conclusion

Fat layer on PMCT is a rare finding but relates to PFE diagnosis, especially of severe histological grade. It is to be expected in a typical position within the pulmonary trunk.
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Metadata
Title
Approaching pulmonary fat embolism on postmortem computed tomography
Authors
Vasiliki Chatzaraki
Jakob Heimer
Michael J. Thali
Garyfalia Ampanozi
Wolf Schweitzer
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Legal Medicine / Issue 6/2019
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-019-02055-8

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