Clinical radiology and postmortem imaging (Virtopsy) are not the same: Specific and unspecific postmortem signs

Christe, Andreas; Flach, Patricia M.; Ross, Steffen; Spendlove, Danny; Bolliger, Stephan A.; Vock, Peter; Thali, Michael J.

doi:10.1016/j.legalmed.2010.05.005

Cited by 190 publications

(138 citation statements)

References 28 publications

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“…17 This is in contradistinction to patients and victims in whom severe blood volume loss was a primary cause of death-in such cases, notable loss of calibre and cross-sectional area will be observed in relation to the cardiac chambers and the great vessels (vena cavae and aorta)-termed "the empty heart phenomenon" by the lead author ( Figure 11). …”

Section: 16mentioning

confidence: 99%

“…It is proposed that the origin of such gas occurring within the vascular tree is the result of the inflow of air secondary to medical venous cannulation and catheterization, pneumatization of dissolved gas within the blood as a result of cardiac massage (chest compressions), pulmonary parenchymal injury as a result of cardiopulmonary resuscitation or a combination of these mechanisms. [16][17][18][19][20] During cardiopulmonary resuscitation, the gas which has reached the described venous structures ascends or descends in a retrograde fashion (for example, to the brain or liver). On post-mortem imaging assessment, because cardiopulmonary resuscitation has not been successful and antegrade venous flow has not been reinstated, the intravascular gas is not carried away from these veins.…”

Section: Cardiovascular and Abdominal Visceral Intravascular Gasmentioning

confidence: 99%

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Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Offiah¹,

Dean²

2016

BJR

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Post-mortem cross-sectional imaging in the form of CT and, less frequently, MRI is an emerging facility in the evaluation of cause-of-death and human identification for the coronial service as well as in assisting the forensic investigation of suspicious deaths and homicide. There are marked differences between the radiological evaluation and interpretation of the CT and MRI features of the live patient (i.e. antemortem imaging) and the evaluation and interpretation of postmortem CT and MRI appearances. In addition to the absence of frequently utilized tissue enhancement following intravenous contrast administration in antemortem imaging, there are a number of variable changes which occur in the tissues and organs of the body as a normal process following death, some of which are, in addition, affected significantly by environmental factors. Many patients and victims will also have undergone aggressive attempts at cardiopulmonary resuscitation in the perimortem period which will also significantly alter post-mortem CT and MRI appearances. It is paramount that the radiologist and pathologist engaged in the interpretation of such post-mortem imaging are familiar with the appropriate non-pathological imaging changes germane to death, the post-mortem interval and cardiopulmonary resuscitation in order to avoid erroneously attributing such changes to trauma or pathology. Some of the more frequently encountered radiological imaging considerations of this nature will be reviewed. INTRODUCTIONPost-mortem cross-sectional imaging assessment in the form of CT and, less frequently, MRI has become an emerging phenomenon in the UK to assist the coronial service in identifying the cause of death non-invasively in individuals where circumstances are non-suspicious or nonhomicidal but where appropriate recent medical history is not available. Such imaging has also become a versatile addition to the armoury available to the forensic pathologist and crime scene investigating (police) authorities in the evaluation of suspicious and homicidal causes of death.

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Section: 16mentioning

confidence: 99%

Section: Cardiovascular and Abdominal Visceral Intravascular Gasmentioning

confidence: 99%

Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Offiah¹,

Dean²

2016

BJR

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“…83,84 Post-mortem scans may have obscuration of lung pathology owing to increase in pulmonary opacification (livor mortis), which can be mistaken for aspiration, pulmonary oedema or pneumonia. 85 These changes build up with greater delay from death to scan, 86 and the best interpretation of lung pathology has been shown within 2 h of death. 87,88 Pulmonary diagnosis is therefore perceived to be difficult in most cases.…”

Section: Respiratory Imaging and Ventilationmentioning

confidence: 99%

Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

Morgan¹,

Adlam²,

Robinson³

et al. 2014

BJR

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The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Postmortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.

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“…Computed tomography (CT) virtual autopsy (virtopsy) represents an effective imaging modality in the diagnosis of drowning, even if drowning can not be diagnosed solely through CT [5][6][7][8][9][10]. In drowning victims, inhaled and aspirated fluid enters the paranasal sinuses as it passes through the nasal cavity; hence, as proved by recent reports, the CT finding of fluid accumulation in the maxillary and sphenoidal sinuses is supportive of the diagnosis of drowning [10][11][12].…”

Section: Introductionmentioning

confidence: 98%

Role of virtopsy in the post-mortem diagnosis of drowning

Vernuccio

Galfano

et al. 2014

Radiol med

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Purpose Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Results All the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops. ConclusionTo date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning.

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Clinical radiology and postmortem imaging (Virtopsy) are not the same: Specific and unspecific postmortem signs

Cited by 190 publications

References 28 publications

Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation

Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

Role of virtopsy in the post-mortem diagnosis of drowning

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