Imaging and Minimally Invasive Biopsy for Postmortem Pulmonary Fat Embolism Diagnosis

Liauw Djai Yen, Clara Valentina J, Gabriella Hamid, Mutiara Jesslyn Taslim, Leonardo Leonardo, Florentina Reddy, Oscar Odillo Laman, Maria Zita


In recent years, imaging technologies and minimally invasive biopsy have been gaining importance in forensic settings. This study aimed to evaluate the role of imaging and minimally invasive biopsy in postmortem diagnosis of pulmonary fat embolism. This was a systematic literature review by using Pubmed, EBSCO-Host, and ProQuest to search for studies on postmortem diagnosis of pulmonary fat embolism with postmortem imaging and minimally invasive biopsy. Five studies were included in the systematic review. These studies employed the following diagnostic technics: postmortem computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), percutaneous needle biopsy (PNB), postmortem magnetic resonance (PMMR), and traditional autopsy. Imaging and minimally invasive biopsy are potential modalities that might complement or even replace traditional autopsy in diagnosing PFE. Further studies are needed to confirm the sensitivity and specificity of each technique.


Imaging, minimally invasive biopsy, postmortem computed tomography, postmortem magnetic resonance, pulmonary fat embolism

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George J, George R, Dixit R, Gupta RC, Gupta N. Fat embolism syndrome. Lung India. 2013;30(1):47–53.

Biswas G. Review of forensic medicine and toxicology. New Delhi. Jaypee Brothers Medical Publishers. 2015.

Filograna L, Bolliger SA, Spendlove D, Schön C, Flach PM, Thali MJ. Diagnosis of fatal pulmonary fat embolism with minimally invasive virtual autopsy and post-mortem biopsy. Legal Medicine. 2010;12(5):233–7.

Moskała A, Woźniak K, Kluza P, Romaszko K, Lopatin O. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents. Leg Med (Tokyo). 2016;18:25–30.

Eriksson EA, Pellegrini DC, Vanderkolk WE, Minshall CT, Fakhry SM, Cohle SD: Incidence of pulmonary fat embolism at autopsy: An undiagnosed epidemic. J Trauma. 2011;71: 312-315.

Gurd AR, Wilson RI. The fat embolism syndrome. The Journal of Bone and Joint Surgery British volume. 1974;56-B(3):408–16.

Flach PM, Ross SG, Bolliger SA, Ampanozi G, Hatch GM, Schön C, et al. Massive systemic fat embolism detected by postmortem imaging and biopsy. J Forensic Sci. 2012;57(5):1376–80.

Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic pulmonary artery embolism: imaging findings and review of the literature. AJR Am J Roentgenol. 2017;208:1–12

Chatzaraki V, Heimer J, Thali MJ, Ampanozi G, Schweitzer W. Approaching pulmonary fat embolism on postmortem computed tomography. Int J Legal Med. 2019;133(6):1879–87.

Makino Y, Kojima M, Yoshida M, Motomura A, Inokuchi G, Chiba F, et al. Postmortem CT and MRI findings of massive fat embolism. Int J Legal Med. 2020;134(2):669–78.

Morikawa K, Hyodoh H, Matoba K, Mizuo K, Okazaki S, Watanabe S. Time-related change evaluation of the cerebrospinal fluid using postmortem CT. Legal Medicine. 2016;22:30–5.

Cox J, Lukande R, Kalungi S, Van de Vijver K, Van Marck E, Nelson A, et al. Practice of percutaneous needle autopsy; a descriptive study reporting experiences from Uganda. BMC Clinical Pathology. 2014;14(1):44.

Bolliger SA, Filograna L, Spendlove D, Thali MJ, Dirnhofer S, Ross S. Postmortem imaging-guided biopsy as an adjuvant to minimally invasive autopsy with CT and postmortem angiography: a feasibility study. AJR Am J Roentgenol. 2010;195(5):1051–6.

Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res. 2017;2(2):52–64.

Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, et al. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings.Respir Med. 2016;113:93–100.

Zaitsu Y, Terae S, Kudo K, Tha KK, Hayakawa M, Fujima N, et al. Susceptibility-weighted imaging of cerebral fat embolism. J Comput Assist Tomogr. 2010;34(1):107–12.

Filograna L, Bolliger SA, Kneubuehl B, Jackowski C, Hatch GM, Thali MJ. A minimally invasive technique for the detection and analysis of pulmonary fat embolism: a feasibility study. J Forensic Sci. 2012;57(5):1329–35.

Neri M, Riezzo I, Dambrosio M, Pomara C, Turillazzi E, Fineschi V. CD61 and fibrinogen immunohistochemical study to improve the post-mortem diagnosis in a fat embolism syndrome clinically demonstrated by transesophageal echocardiography. Forensic Science International. 2010;202(1–3):e13–7.


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