Figure 3d:

(a) Postmortem CT and (b–d) and arterial phase postmortem CT angiography images in a 59-year-old woman who died of internal exsanguination shortly after Whipple surgery. (a) A large left-sided hemothorax with mediastinal shift to the right. During the surgery, supraceliac clamping of the abdominal aorta was performed to stop intraperitoneal bleeding. The clamp was later loosened but left in place (arrow in b). The fatal hemothorax was caused by hemorrhage from the left 11th intercostal artery, which was torn near its origin from the aorta just above the diaphragm during placement of the clamp. The contrast media extravasation from the artery’s origin, reaching cranially into the thorax (arrows in b, c, and d), is displayed on arterial phase postmortem CT angiographic images (c and d). This finding may have been difficult to detect at autopsy because of the small size and location of the vessel. In this case it could not be displayed at autopsy because of large amounts of intraperitoneal and intrathoracic clotted blood, and multiple previous abdominal operations with extensive scar tissue formation and adhesions.