Blood Aspiration as a Vital Sign Detected by Postmortem Computed Tomography Imaging

Abstract

Blood aspiration is a significant forensic finding. In this study, we examined the value of postmortem computed tomography (CT) imaging in evaluating findings of blood aspiration. We selected 37 cases with autopsy evidence of blood in the lungs and/or in the airways previously submitted to total-body CT scanning. The CT-images were retrospectively analyzed. In one case with pulmonary blood aspiration, biopsy specimens were obtained under CT guide for histological examination. In six cases, CT detected pulmonary abnormalities suggestive of blood aspiration, not mentioned in the autopsy reports. CT reconstructions provided additional data about the distribution and extent of aspiration. In one needle-biopsied case, the pulmonary specimens showed blood in the alveoli. We suggest the use of CT imaging as a tool complementary to traditional techniques in cases of blood aspiration to avoid misdiagnosis, to guide the investigation of lung tissue, and to allow for more evidence-based inferences on the cause of death.

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

“…The PMCT image reader may want to determine the nature of tracheobronchial contents and interpret their forensic relevance in terms of the estimation of lethal aspiration and aspiration as a sign of vitality. The present study supports former research that found that measurements of the radiodensity of tracheobronchial contents with HU values can help determine the nature of the contents [10,27,28]. According to Zech et al, in PMCT, contents with HU values between 40 and 80 can be identified as blood.…”

“…However, HU measurements do not reliably allow for determining the nature of tracheobronchial contents. Aspirated stomach contents of food components, for example, or aspiration of external foreign materials may possess radiodensity, which can mimic the HU values of blood or serous fluid materials [5,10,28]. Therefore, measurement of HU values alone does not allow for a safe discrimination between blood, serous fluids originating from lung edema, stomach contents, or other aspirated foreign material.…”

Detection of blood aspiration in deadly head gunshots comparing postmortem computed tomography (PMCT) and autopsy

“…Reviewing the current literature, detection of blood aspiration by PMCT has only been discussed by Filograna et al [13, 22]. They reported cases on a retrospective basis regarding signs of aspiration in autopsy and afterwards PMCT data were retrospectively analyzed for signs of blood aspiration.…”

“…Recently, Filograna et al provided first evidence of the applicability of PMCT in detection of blood aspiration in a gross series of death for different reasons [13]. Therefore, the aim of our study was to analyze the reliability of PMCT versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries.…”

Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death

“…A recent topic of interest in forensic radiology is postmortem imaging using computed tomography (CT) and magnetic resonance imaging (MRI) to complete autopsy or minimize postmortem invasion [1][2][3][4][5][6][7][8][9][10][11][12][13]; however, the priority of autopsy is clear in detection of morphological abnormalities [5]. Full utilization of the potential of the diagnostic imaging procedure is expected to obtain evidence that cannot be detected by conventional autopsy [5,14].…”