Multi-phase post-mortem CT-angiography (MPMCTA) is a very significant tool to explain cardiovascular pathologies. A sudden cardiac death case

Multi-Phase Post-Mortem CT-Angiography (MPMCTA) is a standardized technique performed by a protocol that increases the radiological interpretation by decreasing artifacts due to the perfusion and by reaching a complete filling of the vascular system. The quality of the CT angiographies was evaluated radiologically by observing the opacification of the vascular system and assessing the interpretability of the resulting images, and by comparing radiological diagnoses to conventional autopsy conclusions. Here we describe a sudden death case in which Multi-Phase Post-Mortem CT-Angiography was helpful to define the diagnosis. A 72 year-old man that during a violent quarrel with his wife he complained of thoracic pain, and he suddenly died. Multi-Phase Post-Mortem Computed Tomography Angiography was carried out using the standardized protocol and it visualized the blood in pericardial sac and the ruptured wall situated in the posterior part of the left ventricle, as the contrast agent leaked through the rupture. The following autopsy confirmed the hemopericardium; the inspection of the left ventricle showed on the lateral and posterior wall a darkish and stiff area. Axial slices from the apex to the atrioventricular valves revealed a large area of pale myocardium diffused to the lateral and posterior free wall of the left ventricle, and in the forth section the rupture of the ventricular wall was visible. In all sections the marginal and the posterior branches of the left circumflex artery were totally occluded by darkish thrombosis. This catastrophic complication of the extensive myocardial infarction often remains undiagnosed and constitutes an autopsy finding. In this way the post-mortem imaging, in particular the CT-Angiography, is an useful tool to investigate all the vascular system and it enables better visualization of the ruptured ventricular wall.