Fluid in the Airway of Nontraumatic Death on Postmortem Computed Tomography

Abstract

To evaluate radiographic features of endotracheal/endobronchial fluid in the airway (FA) observed on postmortem computed tomography (PMCT). We studied 164 subjects who died at our hospital between April 2009 and September 2012. Fluid in the airway was considered positive when fluid was identified in the lumen of 1 of the 2 main bronchi in continuity with a segmental bronchus. Pleural effusion and atelectasis/consolidation of the lung lower lobes were also evaluated. Fluid in the airway was observed in 60 (71%) of 84 subjects with unilateral or bilateral pleural effusion, and in 44 (55%) of 80 subjects without pleural effusion (P = 0.029). Of the latter, 41 (93%) had atelectasis/consolidation of the lower lung lobes. Among subjects without pleural effusion, average times after death to PMCT of subjects with and without FA were 501 and 314 minutes, respectively (P = 0.01). Time-course analysis showed that cases with FA on PMCT largely correlated with time after death (R = 0.7966). Fluid in the airway is frequently observed on PMCT in subjects with pleural effusion or atelectasis/consolidation of the lung. No FA in subjects without pleural effusion correlated to shorter times after death. In addition, FA frequency on PMCT increased over time after death.

Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions

“…5A , arrowhead). In our previous study, fluid within the airway was frequently observed on postmortem CT in subjects with pleural effusion or atelectasis/pulmonary consolidation, and the volume of airway fluid increased over time postmortem ( 17 ).…”

“…However, postmortem changes sometimes mimic pathologic lesions and vice versa. Although several studies have examined postmortem CT findings in individual organs ( 12 13 14 15 16 17 18 ), few have evaluated postmortem changes on whole-body postmortem CTs ( 19 20 ). In this pictorial essay, we present a case series of atraumatic in-hospital deaths, characterize the postmortem imaging features on postmortem CT, and discuss the pitfalls of postmortem CT examination and the differential diagnosis of postmortem CT findings.…”

Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings

“…Ishida et al demonstrated that in nontraumatic death cases, the appearance of fluid contents in the airways in PMCT correlated with the time after death [29]. Hyodoh et al showed a decreased aerated lung volume due to fluid accumulations over time after death [30].…”

Comparison of Attenuation of Striated Muscle between Postmortem and Antemortem Computed Tomography: Results of a Longitudinal Study

“…As guidelines for the diagnosis of postmortem images are now being established worldwide, it is important to understand the normal changes on postmortem CT. The postmortem CT features of several organs have already been described [7]–[11]. To our knowledge, however, there are no reports describing the postmortem changes in CT attenuation of striated muscle.…”