• Lei Wan, Yanxiang Song, Zhengdong Li, Maowen Wang, Fengxiang Song, Jianhua Zhang, Donghua Zou, Ningguo Liu, Yuxin Shi, and Zhiyong Zhang.
• Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
• Medicine (Baltimore). 2022 Jan 14; 101 (2): e28544e28544.

RationalePostmortem imaging (PMI), including computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), and postmortem magnetic resonance imaging (PMMRI), is rapidly becoming effective and a practical method in forensic medicine. This study aimed to present a specific forensic case in which the PMI approach and its applications were used.Patient ConcernsA 40-year-old male patient had moderate unilateral nose bleeding constantly 10 times after suffering from a head injury induced by a car accident. After a bilateral massive nose bleeding for the last time, he died from hemorrhagic shock. Traumatic internal carotid artery pseudoaneurysm (TICAP) was suspected in this patient.Diagnosis, Interventions, And OutcomesA whole-body scanning was performed using PMCT and PMMRI. Then, PMCTA using left ventricular cardiac puncture was also implemented. A water-soluble contrast agent was injected into the left ventricle and pumped toward the intracranial, followed by a repeated whole-body PMCT scan. The PMCT/PMMRI detected a high-density/signal mass inside the left sphenoid sinus. The PMCTA detected a distinct leakage of the contrast agent into the left sphenoid sinus from an adjacent aneurysm of the C3 section of the left internal carotid artery. Autopsy and histology confirmed a TICAP inside the sphenoid sinus.LessonsThis case showed that the PMI was of great value for identifying the cause of death in special cases. When vascular lesions are suspected in the body, PMI and especially the PMCTA approach may be an effective detection method.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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