Haruo Maeda

Quantitative analysis of brain edema and swelling on early postmortem computed tomography: comparison with antemortem computed tomography

PurposeThe aim of this study was quantitatively to analyze brain edema and swelling due to early postmortem changes using computed tomography (CT) scans of the head.Materials and methodsReview board approval was obtained, and informed consent was waived. A total of 41 patients who underwent head CT before and shortly after death were enrolled. Hounsfield units (HUs) of gray matter (GM) and white matter (WM) were measured at the levels of the basal ganglia, centrum semiovale, and high convexity area on both antemortem and postmortem CT. The length of the minor axis of the third ventricle at the level of the basal ganglia and the width of the central sulcus at the level of high convexity were measured.ResultsAt each level tested, the HUs of GM and the GM/WM ratios on postmortem CT were significantly lower than those on antemortem CT (P < 0.001). HUs of WM on postmortem CT were slightly higher than those on antemortem CT but without significant difference (P > 0.1). Postmortem CT showed subtle loss of distinction between GM and WM. The size of the third ventricle and the width of the central sulcus did not vary before and after death (P > 0.1).ConclusionEarly postmortem CT shows mild brain edema but does not show brain swelling.

Intrahepatic gas at postmortem multislice computed tomography in cases of nontraumatic death.

PurposeThe purpose of this study was to investigate the cause and significance of intrahepatic gas (IHG).Materials and methodsThere were 208 nontraumatically deceased individuals retrospectively investigated concerning the occurrence and location of IHG by postmortem multislice computed tomography (MSCT) imaging. The location of IHG was graded on a scale from 0 to 3: 0, no gas; 1, gas only in the left lobe; 2, gas in the left lobe and anterior segment of the right lobe; 3, gas in the left lobe and the anterior and posterior segments of the right lobe). We also assessed and noted the occurrence of intestinal distention, airway management, the interval between cardiopulmonary arrest (CPA) and subsequent examination, and the postmortem interval.ResultsIHG was found in 66 cases (31.7%): grade 1, 15 (7.2%); grade 2, 21 (10.1%); grade 3, 30 (14.4%). The presence of IHG was strongly related to intestinal distention and the period between the time of CPA and the examination.ConclusionIHG is a frequent finding on postmortem CT in cases of nontraumatic death. The presence of IHG is related to intestinal distention and the interval between the time of CPA and examination.

Quantitative Analysis of Intracranial Hypostasis: Comparison of Early Postmortem and Antemortem CT Findings

OBJECTIVE The purpose of this study was to quantitatively analyze postmortem hypostasis in the intracranial venous sinus on head CT scans compared with the antemortem CT findings in the same patients with the aim of evaluating sedimentation in the heart and great vessels. MATERIALS AND METHODS A total of 50 patients on whom head CT was performed before and after death were enrolled. Attenuation in the dorsal part of the superior sagittal sinus was measured at the level of the basal ganglia on both antemortem and postmortem CT scans. Increased attenuation in the transverse sinus and cerebellar tentorium and sedimentation in the heart and great vessels were evaluated visually. RESULTS Attenuation in the dorsal part of the superior sagittal sinus increased significantly (p < 0.0001) between antemortem (42.77 ± 6.23 HU) and postmortem (49.72 ± 10.58 HU) CT in 80% of cases. Increased attenuation of the transverse sinus or cerebellar tentorium was observed in 48% of cases and sedimentation in the heart or great vessels in 62% of cases. Increased attenuation in the superior sagittal sinus was clearly evident in patients with sedimentation in the heart or great vessels (antemortem, 43.81 ± 6.17 HU; postmortem, 54.65 ± 8.51 HU) compared with the patients without evidence of sedimentation (antemortem, 41.06 ± 6.10 HU; postmortem, 41.66 ± 8.57 HU) (p < 0.0001). CONCLUSION Intracranial hypostasis is a common postmortem CT finding. Radiologists and physicians who interpret postmortem neurologic images should be aware of intracranial hypostasis and differentiate this phenomenon from intracranial hemorrhage.

Characteristics and CT features of subcarinal air collections/main bronchial diverticula

The aim of this study was to evaluate the characteristics and CT features of subcarinal air collections on thin-section multidetector-row computed tomography (MDCT). Two hundred asymptomatic adult subjects without a history of pulmonary disease underwent MDCT. The CT appearances and characteristics of foci of extraluminal air contiguous to the main bronchus in the subcarinal region were retrospectively analysed. Subcarinal air collections were found in 81 of 200 subjects (41%) and were spotty or microtubular in 67 of 81 subjects and rounded or oval in the other 14. Each subcarinal air focus communicated, or seemed to communicate, with the adjacent bronchus in 76 of 81 cases. Our data demonstrate that extraluminal air foci in the subcarinal region are common CT findings and routinely depicted on thin-section MDCT, and that most of these lesions seem to be main bronchial diverticula. Cystic air foci in the subcarinal region should be called subcarinal air cysts. The precise recognition of these cysts improves the ability to avoid misidentification, such as pneumomediastinum.

Multiple lung tumors as the cause of death in a patient with subarachnoid hemorrhage: postmortem computed tomography study.

A 77-year-old woman who had been in the hospital suffering from a subarachnoid hemorrhage suddenly died after undergoing a cerebral aneurysmal operation. Postmortem whole-body computed tomography (CT) demonstrated multiple lung tumors with abnormal masses in the bronchus with no evidence of complications in the cranium. The patient was estimated to have died from asphyxia caused by metastatic lung and endobronchial tumors. Although a traditional autopsy was not performed, postmortem CT provided strong evidence for detecting the cause of death. In this case, postmortem CT played an important role in hospital risk management.

Main bronchial diverticula in the subcarinal region: Their relation to airflow limitations

Background To date, bronchial diverticula have generally been treated as a pathological condition associated with chronic obstructive pulmonary disease (COPD), although only a limited amount of published information is available on the relationship between bronchial diverticula as depicted by multidetector computed tomography (MDCT) and airflow limitations. Purpose To evaluate the relationship between airflow limitations and main bronchial diverticula in the subcarinal region using spirometry and thin-section MDCT. Material and Methods A total of 189 consecutive adult patients were retrospectively evaluated based on spirometry and thin-section MDCT of the chest. All examinations were performed at our institution between June and October 2008. The study group included 70 women and 119 men with a mean age of 65 years (range 19–86 years). The relationship between the FEV1% and bronchial diverticula in the subcarinal region was analyzed (Students t-test). Results The indications for conducting the examinations were pulmonary diseases (82 patients), cardiovascular diseases (22), extrapulmonary malignancies (74), and other conditions (11). A total of 84/189 (44.4%) patients showed bronchial diverticula, and the FEV1% of 70/84 (83.3%) patients was above 70. The FEV1% of patients with lesions ranged from 26.0 to 97.8 (mean 76.8), whereas the range was 28.1–94.4 (mean 73.7) in those without lesions. There was no significant association between the FEV1% and the presence of subcarinal bronchial diverticula (P > 0.05). Conclusion Our data demonstrate that thin-section chest CT commonly demonstrates main bronchial diverticula in the subcarinal region in patients without airflow limitations. We propose that the presence of a small number of tiny bronchial diverticula under the carina may not be a criterion for the diagnosis of COPD.

Correction to: The sternalis muscle: radiologic findings on MDCT

In the original publication of the article, the seventh author name was incorrectly published as Hidehumi Aoyama. The correct author name should read as Hidefumi Aoyama.

Localized air foci in the lower thorax in the patients with pneumothorax: Skip pneumothoraces

PURPOSE To investigate the characteristics and imaging features of localized air foci in the lower thorax in patients with pneumothorax using thin-section multidetector computed tomography. MATERIALS AND METHODS Of 10,547 consecutive CT examinations comprising the chest, the CT scans of 146 patients with ordinary pneumothoraces were identified and retrospectively evaluated. The study group included 110 male and 36 female patients (mean age, 50 years; range, 1-93 years). All examinations were performed at our institution between January 2009 and December 2009. Cause of pneumothorax was classified as traumatic or non-traumatic. Localized air foci in the lower thorax were defined as being localized air collections in the lower thorax that did not appear to be adjacent to the lung. If these criteria were met, the shape, size, location laterality, and number of foci were evaluated. Associations with trauma, sex, severity of the pneumothorax, and laterality were evaluated using the χ(2) test. All P values <0.05 were considered significant. RESULTS Localized air foci in the lower thorax presented as slit-like or small ovoid air collections in the lowest part of the pleural space. These foci were observed in 79/146 (54.1%) patients. The traumatic pneumothoraces group showed a higher prevalence of these features than the non-traumatic group. Some foci that were situated in the anterior part mimicked the appearance of free intraperitoneal air. CONCLUSION Patients with pneumothorax commonly had localized air foci in the lower thorax. Because such foci can mimic pneumoperitoneum, accurate recognition of them is required to avoid confusion with free intraperitoneal air, especially in traumatic cases.