Case Report Postmortem angiography in computed tomography and magnetic resonance imaging in a case of fatal hemorrhage due to an arterio-venous malformation in the brain q Sabine Franckenberg ⇑ , Claudia Schulze, Stephan A. Bolliger, Dominic Gascho, Michael J. Thali, Patricia M. Flach Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland article info Article history: Received 21 November 2014 Received in revised form 25 November 2014 Accepted 26 November 2014 Available online xxxx Keywords: Virtopsy Cerebral hemorrhage Arterio-venous malformation AVM PMCT PMCTA PMMR PMMRA Angiography abstract Autopsy is the traditional gold standard for determining the cause and manner of death in a forensic death investigation. However, postmortem imaging plays an ever-growing role in preliminary examination, even replacing conventional autopsy in some cases. This case report presents a case of massive intra-axial brain hemorrhage due to an arterio-venous malformation. The cause and manner of death were exclusively determined by postmortem radiology. Based on radiological findings, the autopsy was considered redundant and cancelled by the public prosecutor. Ó 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Postmortem computed tomography (PMCT) and magnetic resonance imaging (PMMR) have become important elements of forensic radiology. These techniques are widely used in routine postmortem forensic investigations, supporting or in some cases even replacing conventional autopsy [1–6]. Based on radiological data of the deceased, forensic pathologists and radiologists are provided with valuable and rapidly acquired information on the cause and manner of death [6,7]. Postmortem computed tomography angiography (PMCTA) was recently introduced to forensic investigations [8,9]. It provides a detailed presentation of the vessel system of the entire body for diagnoses of hemorrhages, vessel ruptures, stenosis, aneurysms and dissections [9–12]. Whereas the feasibility and potential of PMCTA have been lar- gely explored, postmortem magnetic resonance angiography (PMMRA) has been mostly neglected to date, though the literature indicates that the technical quality of PMMRA images is approxi- mately equivalent to PMCTA [13]. Vascular malformations are the most common cause of intrace- rebral hemorrhage in young people. The average annual bleeding risk due to malformation is estimated to be approximately 2% in previously unruptured arterio-venous malformation (AVM) cases, and a high rate of morbidity and mortality [14–17] is noted. The risk of death in the case of brain hemorrhage is 10–15% [18]. So far, direct comparison of CT/CT angiography and MRI/MRI angiography is only described in few clinical cases [19–22]. To our knowledge, in postmortem imaging this case represents the first of its kind where both PMCT(A) and PMMR(A) were applied. 2. Case 2.1. Case history A 42-year-old man did not arrive at work and was found dead at home 1 day later. The flat was normally locked. The lock was drilled to allow access by the police. The deceased was found lying on his bed in a supine position. Stomach content was located on the pillow beneath the head. External examination of the body http://dx.doi.org/10.1016/j.legalmed.2014.11.006 1344-6223/Ó 2014 Elsevier Ireland Ltd. All rights reserved. q Nothing to disclose. ⇑ Corresponding author. Tel.: +41 (0)44 635 56 28; fax: +41 (0)44 635 68 51. E-mail address: Sabine.Franckenberg@gmail.com (S. Franckenberg). Legal Medicine xxx (2015) xxx–xxx Contents lists available at ScienceDirect Legal Medicine journal homepage: www.elsevier.com/locate/legalmed Please cite this article in press as: Franckenberg S et al. Postmortem angiography in computed tomography and magnetic resonance imaging in a case of fatal hemorrhage due to an arterio-venous malformation in the brain. Leg Med (2015), http://dx.doi.org/10.1016/j.legalmed.2014.11.006