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

Abstract

Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.

Can postmortem computed tomography detect antemortem hypoxic–ischemic encephalopathy?

“…Postmortem CT (PMCT) provides the following information: the presence of pre-existing and pathological findings, changes related to the cause of death, nonspecific natural changes occurring in the agonal stage and/or after death, and effects of cardiopulmonary resuscitation. A clear distinction among these parameters is important for precise identification of the cause of death, considering that some PMCT findings that apparently reflect normal postmortem changes can mimic actual pathological lesions [7].…”

Possibilities and Limitations of Virutal Autopsy in Neonatology

“…Так, по данным зарубежных исследователей, посмертный отек легких может как имитировать наличие при-жизненного отека легких, так и скрывать на полученных томограммах наличие очаговой пневмонии [33,34]. Аналогичные явления отно-сятся и к другим посмертным изменениям [35,36]. Значительно ограничены возможности вы-полнения контрастирования внутренних орга-нов и сосудистой системы при лучевых иссле-дованиях и проведения КТ-ангиографии.…”

British Neuropathological Society and International Society of Forensic Radiology and Imaging expert consensus statement for post mortem neurological imaging

“…This allows a reliable assessment of neuroanatomy even in cases of advanced putrefaction and maceration – information which may be lost during dissection. While expected normal post mortem changes over time have been well documented on both post mortem computed tomography (CT) and Magnetic Resonance Imaging (MRI) , diagnostic accuracy rates for the identification of neuropathology in adults are lacking, with the majority of findings described in small case reports and series and mostly utilising CT. Comparatively, in children, the diagnostic accuracy for identification of the presence of pathology in the nervous system at post mortem MRI (PMMR) is higher than that for post mortem CT (PMCT) with estimated sensitivity and specificity rates of 88.4% and 95.2% compared to 60.9% and 85% respectively .…”

“…Neuroimaging may be useful in disaster victim identification , determining the presence of skull fractures and intracranial haemorrhage in nonaccidental injury , crime scene reconstruction or in the investigation of an unexpected and otherwise clinically unexplained death . Nevertheless, robust evidence‐based studies and comprehensive guidelines specifically for post mortem neuroimaging are lacking.…”