Case report Anomalous left coronary artery origin on postmortem imaging in correlation with autopsy Rosa Maria Martinez a,n , Patricia M. Flach a,b , Lars C. Ebert a , Christine Bartsch a , Michael J. Thali a , Garyfalia Ampanozi a a Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland b Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland article info Article history: Received 27 February 2014 Received in revised form 7 March 2014 Accepted 20 March 2014 Keywords: Forensic medicine Coronary artery anomaly Virtopsy Postmortem imaging Segmentation abstract A case of an anomalous origin of the left coronary artery from the right coronary cusp with interarterial course between the aorta and pulmonary artery, detected by autopsy and retrospectively on postmortem computed tomography (PMCT) and magnetic resonance (PMMR) imaging is presented. According to the literature, this type of coronary artery anomaly is highly related with sudden death in young people. Encountering this anomaly in a 75 years old individual as in the case presented here is considered rare, since the anomaly remains mainly undiagnosed if no symptoms are present. The deceased underwent both, PMCT and PMMR examination, prior to autopsy. The autopsy finding could be confirmed on PMCT and PMMR and a three-dimensional segmentation-based reconstruction was performed. With this case report we present a rare coronary artery anomaly which was survived 75 years long and found by coincidence in autopsy, and discuss the distinct advantage of re-evaluation of postmortem images by experts. & 2014 Elsevier Ltd. All rights reserved. 1. Introduction There is a variety of coronary artery normal variations and anomalies, which affect 0.3–1% of the general population [1]. It is a heterogeneous group of congenital disorders with numerous manifestations [2], which do not seem to be equally life- threatening [3]. It is deemed that a separate origin of the conal artery from the right coronary artery (RCA) and also separate origins of the anterior descending and left circumflex arteries are variants within normal [4]. Anomalous origination of a coronary artery from the opposite sinus however, is more often seen in fatal events and especially the interarterial course of an anomalous origin of the left coronary artery (LCA) between the aorta and the pulmonary artery is associated with a severe prognosis [2,5]. Particularly, the LCA originating from the right sinus of Valsalva is mostly associated with sudden death, potentially due to com- pression of the interarterial segment of the coronary artery resulting in myocardial ischemia [6]. Postmortem imaging has been introduced into forensic medicine during the past years and can include postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) examinations, among others [7]. PMCT of the heart allows for assessment of coronary sclerosis and morphologic changes but only little information regarding the myocardial tissue is gained, due to poor soft tissue contrast. PMMR of the heart provides more detail regarding the myocardium [8] and the coronary arteries [9,10]. Advantages of postmortem imaging have been widely discussed in recent literature. It allows for safe and lossless data storage, the reevaluation by experts [11] and for three dimensional reconstruc- tions which are easier understood by lay persons [12] in contrast to results from traditional autopsies. We present a case of an anomalous origin of the left coronary artery from the right coronary cusp (RCC) with interarterial course between the aorta and pulmonary artery, detected by autopsy and retrospectively on PMCT and PMMR. 2. Case history During a holiday stay abroad, a 75 years old female was hospitalized with acute bronchitis. One day later, she had to be transferred to the intensive care unit with a hypertensive crisis. She had to be ventilated. Soft tissue emphysema was noted and a pneumothorax was suspected. While a thoracic drainage was inserted she became bradycardiac and finally died due to cardiac arrest. Based on the daughter's information regarding the health Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jofri Journal of Forensic Radiology and Imaging http://dx.doi.org/10.1016/j.jofri.2014.03.008 2212-4780/& 2014 Elsevier Ltd. All rights reserved. n Corresponding author. Tel.: þ41 44 63 55 611; fax: þ41 44 63 56 851. E-mail addresses: rosita.martinez@irm.uzh.ch, rosita.martinez@virtopsy.com (R.M. Martinez). Please cite this article as: R.M. Martinez, et al., Anomalous left coronary artery origin on postmortem imaging in correlation with autopsy, Journal of Forensic Radiology and Imaging (2014), http://dx.doi.org/10.1016/j.jofri.2014.03.008i Journal of Forensic Radiology and Imaging ∎ (∎∎∎∎) ∎∎∎–∎∎∎