Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient

Abstract

Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.

A review on the evolution and characteristics of post-mortem imaging techniques

“…4.7 Infection -The use of post-mortem imaging has proven to be a valuable tool for the examination of suspected infections. Previous studies and case reports suggest that the use of techniques such as PMCT [67][68][69][70][71][72] and MSCT and MRI [73] can provide nearly as much or more information than traditional autopsy, with some examples where post-mortem imaging managed to identify new diagnostic signs of septicaemia not previously exploited [68,72]. Furthermore some of these studies showcase the value of these non-invasive techniques for their ability to (a) protect the examiner from high risk infectious diseases that might not have been previously identified [70,71]; and (b) guide the pathologist in a more targeted examination of areas that may have been overlooked in a standard autopsy protocol [69].…”