Table 1.
Figure 1.
Sheath in the left common femoral artery after surgical preparation.
Figure 2.
Manual perfusion with a 20 ml syringe via the right common femoral artery.
Figure 3.
Exiting of blood and contrast medium over the sheath in the left common femoral artery.
Figure 4.
Maximum intensity projection of the lower abdomen.
The contrast medium can be very well seen in even small visceral arteries and arteries of the jejunal wall (white arrow).
Figure 5.
Axial view of the chest, soft tissue-windowing.
Big hematomas in the pleural space can be seen (white arrows). Further, the leak of contrast medium from the aortic root directly posterior to the sternotomy can be very well depicted (white arrowhead). Autopsy later confirmed a suture insufficiency and bleeding of aortic root after surgical valve operation.
Figure 6.
Axial view of the heart, soft tissue-windowing.
The scan shows contrast medium between heart and pericardium (white arrow). Autopsy later confirmed an aortic dissection with bleeding into the pericardial space, pericardial rupture and bleeding into the left pleural space which can be seen in Figures 8, 9 and 10.
Figure 7.
a: Axial view of the chest, soft tissue-windowing.
The unenhanced scan shows a big pleural effusion on the left with sedimentation phenomenon (white arrow). The medistinum is pushed to the right with consecutive dystelectasis of the right lung. b: Axial view of the chest, soft tissue-windowing. The contrast enhanced scan of the same patient very well depicts the aortic dissection (black arrow), the pericardial effusion (white arrow) and the blood and contrast medium in the pleural space (white arrowhead). The contrast medium turned out to be heavier than plasma and lighter than blood cells leading to a clear delineation between the two in the hematoma. All findings were later confirmed by autopsy. c: Axial view of the chest, soft tissue-windowing. The Contrast medium leaks downwards from the rupture in the pericardium into the pleural space (white arrow).
Figure 8.
Histologic sample of a renal glomerulum with afferent arteriole (black arrow) and glomerular capillaries (white arrow) filled with contrast medium (PAS, 100x).
Thus, histology proved the perfusion of smalles arteries without unintentional extravasation or shunting to the venous system.
Figure 9.
Axial view of the chest, soft tissue-windowing.
Rupture of the right ventricle (white arrow) with contrast medium exiting into the sternal cavity and dorsal heamatomas in the pleural space (black arrows).
Figure 10.
Axial view of the chest, soft tissue-windowing.
The exiting contrast medium can very well be seen in the dehiscent sternum, directly posterior to the sternal skin clips (white arrow).
Figure 11.
a: paracoronal view of the chest, soft tissue-windowing.
Thrombosis of the ascending aorta with occlusion of coronary arteries can be seen (white arrow). Conventional autopsy later confirmed the diagnosis. b: 3D reconstruction of CT of the same patient shows lack of contrast between left ventricle and ascending aorta due to thrombosis.
Figure 12.
Axial view of the heart, soft tissue-windowing.
The large rupture of the intraventricular septum with contrast medium entering the right ventricle can very well be seen.
Figure 13.
a: axial view of the chest, lung windowing.
Ground-glass like lung and pleural effusion due to pulmonary edema. Yet no collapse of the lungs because of postmortem ventilation. b: axial view of the chest, lung windowing. Normally expanded lungs because of postmortem ventilation.
Figure 14.
Axial view of the chest, mediastinal windowing.
Haematomas in the thorax. The exiting of contrast medium from the aortic root can be very well depicted (white arrow). Autposy later confirmed suture insufficiency of the aortic root.
Figure 15.
3D reconstruction of - cranial CT-Angiography after bone-removal.
The white arrow shows the occlusion of the right internal carotid artery (white arrow) and the lack of vessel opacification in the right hemisphere.
Figure 16.
Comparison of LOC in unenhanced and contrast-enhanced scans.
Level of confidence for each scan with error bars. The red bars indicate contrast-enhanced scans; the blue bars indicate non-enhanced scans, showing a significantly higher LOC for contrast enhanced scans (p = 0,001).