The impact of multiphase post-mortem CT- angiography (MPMCTA) for investigating fatal outcomes of medical interventions

Post-mortem imaging - predominantly computed tomography (PMCT) - has proven its suitability in reported casework experience of suspected fatal medical errors to become an integral part of routine pre-autopsy forensic investigations. However, its role in mortality analysis within the context of hospital quality management is still under consideration. Post-mortem imaging combined with angiography procedures can effectively assist forensic autopsy investigations of unexpected and periprocedural deaths as they both offer a significant improvement in documenting medical complications. They help to identify misplaced medical devices, sources of haemorrhages, vascular patency, and unimpaired perfusion after general and cardiovascular surgery, complications after transvascular catheter-directed interventions or distinctive and potentially contributing features of vascular anatomy. Complications in transplant surgery demonstrate the significant impact of multiphase CT angiography (MPMCTA) as a standardised method of post-mortem opacification of the vasculature in the evaluation of bleeding complications following complex vascular surgery. Complicated transcatheter aortic valve implantations (TAVI) serve as examples for the application of MPMCTA in order to clarify fatal outcomes of catheter-guided minimal invasive interventions. Single casework experience favours that PMCT and PMCTA assist forensic or clinical autopsies to reconstruct adverse medical events with fatal outcomes or contribute substantially to prove a non- complicated interventional approach.