A bridge from clinical questions to pathological answers

Clinical History

At birth, a female neonate with trisomy 21 had an umbilical venous catheter placed; portable radiograph imaging confirmed placement (Fig. 1). Imaging indicated the catheter followed an aberrant course. The infant died on day 5 of life due to other comorbidities. Post-mortem virtual autopsy and pathology demonstrated interesting results.

Imaging Findings

Portable chest radiographs (Fig. 1) performed on day 2 of life showed that the umbilical venous catheter followed an aberrant course with the tip near the dome of the liver. Post mortem magnetic resonance imaging revealed multiple abnormalities to include pleural effusions, ascites, anasarca, and pneumomediastinum. Additionally, a focal heterogeneous signal abnormality was noted at the dome of the liver which was revealed as a hepatic infarct. This corresponded with the previously identified location of the tip of the umbilical venous catheter. In this case, the hepatic infarct may have gone unnoticed if the standard autopsy was performed without the complement of post-mortem imaging.

Discussion

Background: This case presentation highlights the value of post-mortem imaging of a neonate in providing specific guidance for the Pathologist to identify a focal liver lesion as a site of possible hepatic infarct.

Clinical Perspective: Abnormalities detected on post-mortem imaging can direct an autopsy dissection to focal areas of interest and/or lesions that might otherwise be overlooked when performing a standard post-mortem autopsy [1].

Imaging Perspective: Post-mortem imaging identified a hepatic infarct that was due to the use of an umbilical venous catheter with aberrant course. Post-mortem imaging complements and improves the accuracy of standard autopsy examinations [2]. Comprehensive cross-sectional diagnostic imaging is increasingly utilized as an adjunct to pathologic autopsy [3].

Outcome: It is important to note that while the hepatic infarct was not the primary cause of death in this case, the utility of imaging as an adjunct to standard autopsy is clearly demonstrated. Diagnostic cross-sectional imaging is a useful tool in post-mortem evaluations [3]. In addition to providing high-resolution examinations of the entire body to assess potential anatomic and pathologic abnormalities, virtual autopsy adds value to the standard autopsy process to precisely pinpoint focal areas of the body which may warrant further investigation [2]. In this case, the hepatic infarct may have gone unnoticed if the standard autopsy was performed without the complement of post-mortem imaging.

Take Home Message: Post-mortem imaging is a promising field of study which has the potential to increase the comprehensive accuracy of standard autopsy, and is expected to continue to play an increasing role in forensic science.

Differential Diagnosis List

Final Diagnosis

Hepatic infarct

URL:	https://www.eurorad.org/case/13339
DOI:	10.1594/EURORAD/CASE.13339
ISSN:	1563-4086