Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium

Objectives When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT. Materials and methods We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding. Results Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases). Conclusions PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.