Abdominal Stab Wounds with Tension Pneumopericardium Confirmed by Autopsy and Postmortem Computed Tomography

We present the first report of pneumopericardium observed by autopsy and on postmortem computed tomography (PMCT) images. The subject was a woman who died of self‐inflicted stab wounds to the abdomen. The PMCT scan revealed air in the pericardial sac, a “flattened heart” sign, and retroperitoneal he...

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Bibliographic Details
Published in:Journal of forensic sciences 2019-09, Vol.64 (5), p.1544-1547
Main Authors: Ro, Ayako, Chiba, Shoetsu, Sagi, Morihisa, Kageyama, Norimasa, Hayashida, Makiko, Ikawa, Toru, Oide, Yukino, Ichiba, Kazue, Mukai, Toshiji
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Injuries - diagnostic imaging
Abdominal Injuries - pathology
Adult
Aorta
Aorta, Abdominal - injuries
Aorta, Abdominal - pathology
Autopsies
Autopsy
Cardiac Tamponade - etiology
Computation
Computed tomography
Diaphragm (anatomy)
Female
Forensic Medicine
Forensic pathology
forensic science
Heart
Hemorrhage
Hemorrhage - diagnostic imaging
Hemorrhage - pathology
Humans
Hypovolemia
low‐pressure cardiac tamponade
medicolegal autopsy
Pericardium
pneumopericardium
Pneumopericardium - diagnostic imaging
Pneumopericardium - pathology
postmortem computed tomography
stab wound
Suicide
Thorax
Tomography, X-Ray Computed
Wounds, Stab - diagnostic imaging
Wounds, Stab - pathology
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Summary:We present the first report of pneumopericardium observed by autopsy and on postmortem computed tomography (PMCT) images. The subject was a woman who died of self‐inflicted stab wounds to the abdomen. The PMCT scan revealed air in the pericardial sac, a “flattened heart” sign, and retroperitoneal hemorrhage. Medicolegal autopsy revealed two abdominal stab wounds near the xiphoid process that had cut the apical pericardium and adjacent diaphragm and liver. Examination of the open thorax confirmed that the pericardial sac was distended with air. The wound extended to the abdominal aorta, causing retroperitoneal hemorrhage. PMCT images showed that the pneumopericardial volume was 133 mL. We believe that cardiac tamponade occurred resulting from the tension pneumopericardium; however, the effects were mitigated by hypovolemia secondary to the retroperitoneal hemorrhage as well as obstructive shock. Therefore, the cause of death appears to have been low‐pressure cardiac tamponade.
ISSN:0022-1198
1556-4029
DOI:10.1111/1556-4029.14028