Diagnosing coronary artery dissection using virtual autopsy in a resource-poor setting- a case report.

Introduction: The development of technology has significantly impacted the evolution of autopsy techniques worldwide. Initially described by Richard Dirnhofer, the concept of "Virtual Autopsy (VA)" or "Virtopsy" involves combining innovative technology with Conventional Autopsy (CA). This has permitted a non-/minimally invasive approach to postmortem examinations.

Case report: A 65-year-old male, a known patient with ischaemic heart disease, hypertension, and dyslipidaemia, who had defaulted treatment, was found dead at home. The body was brought to the National Hospital Kandy for post-mortem examination. The internal dissection revealed a haemopericardium of 50 ml. Bleeding into the epicardial tissue throughout the course of the circumflex artery was noted. With the suspicion of coronary artery aneurysm rupture/dissection, ex-situ contrast-enhanced radiography was done on the heart to identify the point of bleeding. This was done by cannulating the left coronary ostia, through which a contrast dye was injected and X-ray images taken. With the assistance of the radiographs combined with careful dissection and histology, circumflex artery dissection and the rupture site were identified more accurately.

Conclusion: VA has many uses, as an adjunct to CA to accentuate the findings of CA and enable targeted system-specific CA. Based on various factors such as the availability of technology, expertise, and post-mortem rate, the use of VA should be customized to each country to obtain the maximum benefits.