Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report

Abstract Background In the present case, we applied postmortem computed tomography angiography (PMCTA) in a medical dispute involving sudden death after cardiovascular surgery. Case presentation A 39-year-old man underwent aortic arch replacement combined with stented elephant trunk implantation sur...

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Main Authors: Wang Zhuoqun, Tian Zhiling, Wan Lei, Dong Hewen, Zou Donghua, Zhang Jianhua, Liu Ningguo
Format: Article
Language:English
Published: BMC 2023-08-01
Series:Journal of Cardiothoracic Surgery
Subjects:
Online Access:https://doi.org/10.1186/s13019-023-02353-8
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author Wang Zhuoqun
Tian Zhiling
Wan Lei
Dong Hewen
Zou Donghua
Zhang Jianhua
Liu Ningguo
author_facet Wang Zhuoqun
Tian Zhiling
Wan Lei
Dong Hewen
Zou Donghua
Zhang Jianhua
Liu Ningguo
author_sort Wang Zhuoqun
collection DOAJ
description Abstract Background In the present case, we applied postmortem computed tomography angiography (PMCTA) in a medical dispute involving sudden death after cardiovascular surgery. Case presentation A 39-year-old man underwent aortic arch replacement combined with stented elephant trunk implantation surgery under extracorporeal circulation. All vital signs were stable and he was arranged for discharge seven days after surgery. Several days later, the patient was sent back to the hospital for chest pain and poor appetite. Unfortunately, his condition worsened and he ultimately died. PMCT scanning detect pericardial effusion. Family members suspected that the surgical sutures were not dense enough, causing the patient’s postoperative bleeding and resulting in cardiac tamponade and death. PMCTA was performed before autopsy, which showed pericardial effusion. However, postmortem angiography with simulated blood pressure showed no leakage of contrast agent, which guided the subsequent autopsy and histological examinations. Conclusions While many previous postmortem imaging case reports have shown positive results that provided evidence of medical malpractice, the current case excludes the possibility of physician negligence and reasonably settles the medical dispute from another perspective. In short, the PMCTA approach we describe here was an effective tool that can be applied to certain medical-related forensic cases.
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spelling doaj.art-f5aef032c7694abba01c6bae58535bb72023-11-20T10:52:55ZengBMCJournal of Cardiothoracic Surgery1749-80902023-08-011811810.1186/s13019-023-02353-8Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case reportWang Zhuoqun0Tian Zhiling1Wan Lei2Dong Hewen3Zou Donghua4Zhang Jianhua5Liu Ningguo6Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeShanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of JusticeAbstract Background In the present case, we applied postmortem computed tomography angiography (PMCTA) in a medical dispute involving sudden death after cardiovascular surgery. Case presentation A 39-year-old man underwent aortic arch replacement combined with stented elephant trunk implantation surgery under extracorporeal circulation. All vital signs were stable and he was arranged for discharge seven days after surgery. Several days later, the patient was sent back to the hospital for chest pain and poor appetite. Unfortunately, his condition worsened and he ultimately died. PMCT scanning detect pericardial effusion. Family members suspected that the surgical sutures were not dense enough, causing the patient’s postoperative bleeding and resulting in cardiac tamponade and death. PMCTA was performed before autopsy, which showed pericardial effusion. However, postmortem angiography with simulated blood pressure showed no leakage of contrast agent, which guided the subsequent autopsy and histological examinations. Conclusions While many previous postmortem imaging case reports have shown positive results that provided evidence of medical malpractice, the current case excludes the possibility of physician negligence and reasonably settles the medical dispute from another perspective. In short, the PMCTA approach we describe here was an effective tool that can be applied to certain medical-related forensic cases.https://doi.org/10.1186/s13019-023-02353-8Postmortem computed tomography angiographyCardiac surgeryAortic dissectionMedical disputeForensic pathology
spellingShingle Wang Zhuoqun
Tian Zhiling
Wan Lei
Dong Hewen
Zou Donghua
Zhang Jianhua
Liu Ningguo
Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
Journal of Cardiothoracic Surgery
Postmortem computed tomography angiography
Cardiac surgery
Aortic dissection
Medical dispute
Forensic pathology
title Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
title_full Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
title_fullStr Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
title_full_unstemmed Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
title_short Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report
title_sort application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery a forensic case report
topic Postmortem computed tomography angiography
Cardiac surgery
Aortic dissection
Medical dispute
Forensic pathology
url https://doi.org/10.1186/s13019-023-02353-8
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