Clinical Conditions Demonstrable By Postmortem Roentgenograms

Principally, most roentgenologic diagnostic methods that do not require cooperation of the patient or a functioning circulation can be done in the autopsy setting. The most important indications and methods are listed here. It should be noted that many of the indications may have medicolegal implications.

• Gas embolism, pneumothorax, pneumomediastinum, and pneumoperitoneum generally are easy to identify in appropriate roentgenograms. Without this technique, these conditions may be totally missed or the diagnosis must be based on a fleeting impression because only roentgenograms can provide a permanent record. However, the important distinction between air and putrefaction gases must be made. Whereas the changes in a tension pneumothorax are diagnostic (for an illustration, see "Pneumothorax" in Part II), air embolism may be simulated by putrefaction gases. The presence of other putrefactive changes and the analysis of the gas (page 290) should provide the correct diagnosis;

• Angiographically demonstrable vascular abnormalities. Coronary artery disease (see below), congenital coronary abnormalities, pulmonary vascular disease (2), mesenteric, splenic (3), or hepatic artery occlusion, cerebral artery aneurysm, or arteriovenous malformations (4), renal artery stenosis or renal vein thrombosis, vascular tumors, and many other arterial and venous lesions that can be demonstrated in situ or on isolated organs;

• Cholangiography. Typical indications are primary sclerosing cholangitis and Caroli's disease (5);

• Postoperative autopsies. Roentgenographic techniques, including angiography (6), may be most helpful to find and document operative mishaps or postoperative complications such as anastomotic arterial occlusion or iatro-genic tension pneumothorax as described earlier;

Fig. 12-1. Use of roentgenogram in medicolegal cases: deflected bullet lodged at base of skull. The entrance wound of this 38 caliber bullet was found on the back, over the left scapula, but during dissection at autopsy, the bullet could not be found. The roentgenogram shows two small bullet fragments, clearly visible in the soft tissue of the left shoulder but the remainder of the bullet had been deflected upward and was found in a deformed state at the level of the foramen magnum (arrow heads), just to the left of the midline.

Fig. 12-1. Use of roentgenogram in medicolegal cases: deflected bullet lodged at base of skull. The entrance wound of this 38 caliber bullet was found on the back, over the left scapula, but during dissection at autopsy, the bullet could not be found. The roentgenogram shows two small bullet fragments, clearly visible in the soft tissue of the left shoulder but the remainder of the bullet had been deflected upward and was found in a deformed state at the level of the foramen magnum (arrow heads), just to the left of the midline.

• Postinfectious, dystrophic calcification as in pulmonary tuberculosis (1) or parasitic diseases, or metastatic calcifications (e.g., in lungs, stomach, or kidneys) in hyperparathyroidism;

• Traumatic, neoplastic, metabolic, and other skeletal diseases.

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