Volume 30, Pages (January 2018)

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Volume 30, Pages 46-51 (January 2018) Usefulness of coronary postmortem computed tomography angiography to detect lesions in the coronary artery and myocardium in cases of sudden death Hiroyuki Takei, Rie Sano, Yoichiro Takahashi, Keiko Takahashi, Yoshihiko Kominato, Hiroyuki Tokue, Takehiro Shimada, Sachiko Awata, Satoshi Hirasawa, Naoya Ohta Legal Medicine Volume 30, Pages 46-51 (January 2018) DOI: 10.1016/j.legalmed.2017.11.005 Copyright © 2017 Elsevier B.V. Terms and Conditions

Legal Medicine 2018 30, 46-51DOI: (10.1016/j.legalmed.2017.11.005) Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 1 Findings of histopathological examination and coronary PMCTA in case 6 (AAOCA). A. Macroscopic view of two coronary artery routes around the aorta and pulmonary artery in the fixed heart. Red dot indicates the left coronary artery and blue dot denotes the right coronary artery. Since the pulmonary artery is shown in the upper part of the panel and the aorta is in the middle part, the left coronary artery takes an interarterial course. B. Anomalous left coronary artery arising at the right aortic sinus of Valsalva. A separate ostium of each coronary artery is filled with a deposit of white contrast medium. Red arrow head indicates the ostium of the left coronary artery and blue one dot denotes that of the right coronary artery. C. 3D volume-rendered image of the coronary arteries. This image was constructed from coronary PMCTA. Red dot indicates the left coronary artery and blue dot denotes the right coronary artery. Deposits of contrast medium are visible on the left and right aortic valves. D. Macroscopic view of branching of the left and right coronary arteries. A slice showing each coronary ostium was prepared by dissection of the aorta. White contrast medium remaining is visible in the lumen of each coronary artery. The red dot indicates the ostium of the left coronary artery and the blue dot denotes that of the right coronary artery. The intramural length between the ostium of the left coronary artery and the point where the left coronary artery left the aorta was 11.8 mm. Legal Medicine 2018 30, 46-51DOI: (10.1016/j.legalmed.2017.11.005) Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 2 Findings of coronary PMCTA and histopathological examination in case 7 (HOCM). A. Long axis image of the heart. This image was constructed from the MIP images. Aortic sinus is indicated by ‘×’. LV denotes the left ventricle and RV indicates the right ventricle. Deposit of contrast medium is evident at the bottom in the cavity of the left ventricle. B. Macroscopic views of both ventricles in serial cross-sections of the fixed heart. The septum appears whitish, consistent with filling of contrast medium within small vessels, as shown by microscopic examination and coronary PMCTA. LV denotes the left ventricle and RV indicates the right ventricle. C. Histological view of the septum. This tissue specimen was obtained from the upper section in panel B, and stained with hematoxylin & eosin. Gray deposit of contrast medium is observed in the vessels. Magnification, ×50. Legal Medicine 2018 30, 46-51DOI: (10.1016/j.legalmed.2017.11.005) Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 3 Findings of coronary PMCTA and microscopic examination in case 8 (acute myocarditis). A. Long axis image of the heart. This image was constructed from the MIP images. Left atrium is denoted by ‘*’ and right atrium is indicated by ‘×’. LV denotes the left ventricle and RV indicates the right ventricle. Deposit of contrast medium is evident at the bottom in the cavity of the left ventricle. B. Histological view of the left ventricle. This tissue specimen was obtained from the anterior wall of the left ventricle, and stained with hematoxylin & eosin. Gray deposit of contrast medium is evident in the vessels. Magnification, ×100. Legal Medicine 2018 30, 46-51DOI: (10.1016/j.legalmed.2017.11.005) Copyright © 2017 Elsevier B.V. Terms and Conditions