Pulmonary thromboembolism on unenhanced postmortem computed tomography: Feasibility and findings

• PTE presents with a characteristic pattern within the pulmonary arteries.
• Subjective identification of lower extremity edema is a marker of PTE.
• Objective measurements of lower extremities edema were not statistically significant.
• PMCT aids in detection of natural causes of death such as PTE.

PurposeThe purpose of this study was to evaluate the feasibility of diagnosing fatal pulmonary thromboembolism (PTE) with unenhanced postmortem computed tomography (PMCT).Materials and methodsTwelve cases with autopsy confirmed PTE and matched controls (n = 19) were retrospectively examined for PTE signs on PMCT. The following variables were evaluated: edema of the lower extremities (areal and Hounsfield Unit measurements) and observer dependent patterns of the morphology of the sedimentation in the pulmonary arteries and trunk.ResultsThe median absolute difference between the areal measurements of the right and left lower leg and thigh and the attenuation of the popliteal adipose tissue did not differ significantly between the groups. In contrast, the categorical assessment of soft tissue edema in the lower extremities was significantly different. A statistically significant difference could also be found in the shape of the vascular content within the pulmonary trunk and arteries.ConclusionPTE may be assessed on unenhanced PMCT using diagnostic clues such as a distinct pattern of the pulmonary artery content and the presence of perivascular edema in the lower extremities.