Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum

Aim: The aim of this retrospective study was to determine the accuracy of postmortem computed tomography and different radiological signs for the determination of the bleeding source in cases with hemoperitoneum confirmed at autopsy. Methods: Postmortem computed tomography data of consecutive cases with hemoperitoneum confirmed at autopsy were reviewed by two raters, blinded to the autopsy findings. The determination of possible bleeding sources was based on the presence of the sentinel clot sign, blood or sedimented blood surrounding an organ, intraparenchymal abnormal gas distribution, and parenchymal disruption. The bleeding source and the cause of hemoperitoneum (traumatic, surgical, natural, or resuscitation) as reported in the autopsy report were noted. The survival intervals of the deceased were calculated when information about the time of an incident related to death was available in the autopsy reports. Results: Eighty-five cases were included in the study. Postmortem computed tomography showed 79% sensitivity and 92.1% specificity for the detection of the bleeding source. The sentinel clot sign was associated with surgical or natural causes of hemoperitoneum and longer survival intervals. Sedimented blood around the bleeding source was associated with resuscitation. Abnormal gas distribution within organs and combination of multiple radiological signs provided higher sensitivity. Conclusion: Postmortem computed tomography provides moderate sensitivity and high specificity for determining the bleeding source in cases with hemoperitoneum. Different PMCT signs are associated with different causes of hemoperitoneum and survival intervals

Prevalence of calcified epiglottis in postmortem computed tomography. Is there a correlation to failed endotracheal intubation?

Objectives: Calcification of the epiglottis is a normal physiological degenerative process, although it can also be a consequence of infection or trauma. There are three possible forensically relevant consequences from epiglottic calcification: misinterpretation as foreign bodies, dysphagia as a major contributing factor to aspiration, and association with difficult intubation or a misplaced ventilation tube. It is the aim of this study (I) to inquire about the prevalence of epiglottic calcification in postmortem CT in general and (II) to investigate whether calcification of the epiglottis is linked to a higher incidence of failed endotracheal intubation. Methods: We retrospectively analysed 2930 consecutive cases in postmortem CT at the Institute of Forensic Medicine. Results: The prevalence of epiglottic calcification was 4.1%. Higher age and male sex are associated with an increased risk of epiglottic calcification. There was no calcification of the epiglottis in the cases with misplacement of the ventilation tube in the esophagus. Conclusions: To verify the result of our study, that is, the calcification of the epiglottis is not linked to a higher incidence of failed endotracheal intubation, it might be reasonable to repeat this study with a more representative study population. The high interindividual variations of calcified epiglottis could be used for identification

Μετρήσεις του αριστερού τοιχώματος του μυοκαρδίου σε μεταθανάτια απεικόνιση σε σύγκριση με τη νεκροτομή

The aims of this study were, firstly, to determine the relationship of left ventricular wall thickness (LVWT) measurements between postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMR) and, secondly, to assess the utility of postmortem imaging for LVWT measurements compared to autopsy. All cases ≥18years old, with postmortem interval ≤4days, cardiac PMCT, PMMR, and full forensic autopsy, were reviewed in our database retrospectively. Exclusion criteria were gas accumulations in the myocardial wall and cardiac trauma. LVWT on PMCT and PMMR was assessed. The measurements were repeated by the same rater after 2months. Autopsy reports were reviewed, and LVWT and pericardial fluid volume measured at autopsy were noted. Pericardial fluid volume >50ml was determined positive for pericardial effusion. A total of 113 cases were included in the study. Twelve cases had pericardial effusion. Intrarater reliability for imaging based LVWT was excellent. LVWT (free wall) was significantly larger on PMCT (18.3mm) compared to PMMR (17.6mm), but these measurements correlated positively. LVWT (anterior wall) was significantly larger on PMMR (15mm) than at autopsy (14mm), and these measurements also correlated positively. Pericardial effusions led to larger differences between PMMR and autopsy measurements, however without statistical significance. There exist discrepancies between LVWT as measured on postmortem imaging and at autopsy. Specialists should be aware in order to not misinterpret imaging measurements.Οι στόχοι αυτής της μελέτης ήταν, πρώτον, να προσδιοριστεί η σχέση των μετρήσεων του πάχους τοιχώματος της αριστερής κοιλίας μεταξύ μεταθανάτιας αξονικής τομογραφίας και μεταθανάτιας μαγνητικής τομογραφίας και, δεύτερον, η αξιολόγηση της χρησιμότητας της μεταθανάτιας απεικόνισης για τις μετρήσεις του πάχους τοιχώματος της αριστερής κοιλίας σε σύγκριση με τη νεκροτομή. Όλες οι σοροί ηλικίας ≥18 ετών, με μεταθανάτιο διάστημα ≤4 ημερών, μεταθανάτια αξονική και μαγνητική τομογραφία καρδιάς και νεκροτομή εξετάστηκαν στη βάση δεδομένων μας αναδρομικά. Κριτήρια αποκλεισμού ήταν οι συσσώρευση αερίων στο μυοκάρδιο και το τραύμα καρδιάς. Το πάχος του τοιχώματος της αριστερής κοιλίας μετρήθηκε στη μεταθανάτια αξονική και μαγνητική τομογραφία. Οι μετρήσεις επαναλήφθηκαν από τον ίδιο αξιολογητή μετά από 2 μήνες. Το πάχος τοιχώματος της αριστερής κοιλίας και ο όγκος του περικαρδιακού υγρού που μετρήθηκαν στη νεκροτομή καταγράφηκαν με βάση τις νεκροτομικές αναφορές. Ο όγκος περικαρδιακού υγρού >50 ml προσδιορίστηκε ως θετικός για παρουσία περικαρδιακής συλλογής. Στη μελέτη συμπεριλήφθηκαν συνολικά 113 περιπτώσεις, δώδεκα με περικαρδιακή συλλογή. Η ενδοπροσωπική στατιστική αξιοπιστία για τις μετρήσεις στην απεικόνιση ήταν εξαιρετική. Το πάχος του πλάγιου τοιχώματος της αριστερής κοιλίας ήταν στατιστικά σημαντικά μεγαλύτερο στην αξονική (18,3 mm) σε σύγκριση με τη μαγνητική τομογραφία (17,6 mm) αλλά αυτές οι μετρήσεις συσχετίστηκαν θετικά. Το πάχος του προσθίου τοιχώματος ήταν στατιστικά σημαντικά μεγαλύτερο στη μαγνητική τομογραφία (15 mm) συγκριτικά με τη νεκροτομή (14 mm) και αυτές οι μετρήσεις συσχετίστηκαν επίσης θετικά. Η παρουσία περικαρδιακής συλλογής οδήγησε σε μεγαλύτερες διαφορές μεταξύ των μετρήσεων στη μαγνητική τομογραφία και τη νεκροτομή χωρίς όμως στατιστική σημαντικότητα.Υπάρχουν αποκλίσεις μεταξύ των μετρήσεων του πάχους τοιχώματος της αριστερής κοιλίας στη μεταθανάτια απεικόνιση και τη νεκροτομή. Οι ειδικοί πρέπει το λαμβάνουν υπόψη για να μη παρερμηνεύονται οι μετρήσεις της απεικόνισης

Nasal septum defects detected on postmortem computed tomography

Nasal septum defects may have forensic relevance because they are associated with various mechanisms, including trauma and cocaine abuse. Like all human body tissues, the nasal septum may be affected by maggots' infestation during postmortem decomposition. Postmortem computed tomography (PMCT) can reveal small findings and related details. Three cases of early postmortem period and 2 cases of advanced decomposition, where external examination of the nasal cavities and PMCT revealed nasal septum defect, are presented. In the early postmortem period cases, the lesions' edges appeared smoother on PMCT, whereas in the advanced decomposed cases, the edges were irregular and maggots were infested. Postmortem computed tomography can detect nasal septum defects and may help differentiate the preexisting from the postmortem ones based on their edges' radiological appearance. Such findings may indicate possible chronic cocaine abuse (cocaine nose), trauma, or other nasal pathology. It is important to note that such defects may be altered or caused by advanced decomposition

Evaluation of the mediastinal-thoracic volume ratio on postmortem computed tomography

Objectives: The aim of this study was to measure the mediastinal-thoracic volume ratio (CTR_VOL) on PMCT as a more accurate version of traditional CTR, in order to assess the terminal positional relationship between the heart and lungs in the different causes of death with regard to age, gender, BMI, cardiomegaly, and lung expansion. Materials: Two hundred fifty consecutive postmortem cases with pre-autopsy PMCT and full forensic autopsy were retrospectively evaluated. The lungs and the mediastinum were manually segmented on the PMCT data and the correspondent volumes were estimated in situ. CTR_VOL was calculated as the ratio of the mediastinal to the thoracic volume. The volume measurements were repeated by the same rater for the evaluation of the intrarater reliability. Age, gender, body weight and height, heart weight at autopsy, and cause of death were retrieved from the autopsy reports. Presence of lung expansion was radiologically evaluated in situ. Results: CTR_VOL was positively associated with age and BMI but not with gender and was higher for cardiomegaly compared to normal hearts, lower for asphyxiation-related deaths compared to cardiac deaths and intoxications, and lower for cases with lung expansion. The intrarater reliability was excellent for the calculated volumes of both lungs and mediastinum. Conclusion: The results of the present study support CTR_VOL as a tool to assess the relationship between the heart and lungs in situ, which differs significantly between the studied cause of death categories

Effects of blood loss on organ attenuation on postmortem CT and organ weight at autopsy.

BACKGROUND Cases of external hemorrhage are difficult to recognize on postmortem computed tomography (PMCT). PURPOSE To investigate the effects of blood loss on CT attenuation of the spleen, liver, kidneys, and lungs on PMCT and to assess the relationship between blood loss and organ weight. METHODS A total of 125 cases with blood loss were sex- and age-matched to 125 control cases without blood loss. Individual organ attenuation was measured on transverse CT images. Organ weights of the liver, spleen, kidneys, and lung were extracted from the autopsy protocols. RESULTS Organ weight was significantly lower in cases with blood loss (lung 30%, spleen 28%, kidneys 14%, liver 18%) than in controls. CT attenuation of the lungs was significantly lower (30%) in cases with blood loss than in controls. CT attenuation of the spleen and kidneys did not significantly differ between cases and controls. CT attenuation of the liver was significantly higher (25%) in cases with blood loss than in controls. CONCLUSION Blood loss decreases organ weight and CT attenuation of the lungs but appears to have no significant effect on CT attenuation of the spleen and kidneys. The increased liver attenuation in cases with blood loss compared to controls was an unexpected finding and remains challenging to explain. One probable interpretation refers to different levels of hepatic glycogen; however, further work is warranted to substantiate this hypothesis

Effects of blood loss on organ attenuation on postmortem CT and organ weight at autopsy

Background: Cases of external hemorrhage are difficult to recognize on postmortem computed tomography (PMCT). Purpose: To investigate the effects of blood loss on CT attenuation of the spleen, liver, kidneys, and lungs on PMCT and to assess the relationship between blood loss and organ weight. Methods: A total of 125 cases with blood loss were sex- and age-matched to 125 control cases without blood loss. Individual organ attenuation was measured on transverse CT images. Organ weights of the liver, spleen, kidneys, and lung were extracted from the autopsy protocols. Results: Organ weight was significantly lower in cases with blood loss (lung 30%, spleen 28%, kidneys 14%, liver 18%) than in controls. CT attenuation of the lungs was significantly lower (30%) in cases with blood loss than in controls. CT attenuation of the spleen and kidneys did not significantly differ between cases and controls. CT attenuation of the liver was significantly higher (25%) in cases with blood loss than in controls. Conclusion: Blood loss decreases organ weight and CT attenuation of the lungs but appears to have no significant effect on CT attenuation of the spleen and kidneys. The increased liver attenuation in cases with blood loss compared to controls was an unexpected finding and remains challenging to explain. One probable interpretation refers to different levels of hepatic glycogen; however, further work is warranted to substantiate this hypothesis

Left myocardial wall measurements on postmortem imaging compared to autopsy

Purpose: The aims of this study were, firstly, to determine the relationship of left ventricular wall thickness (LVWT) measurements between postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMR) and, secondly, to assess the utility of postmortem imaging for LVWT measurements compared to autopsy. Materials and methods: All cases ≥18 years old, with postmortem interval ≤4 days, cardiac PMCT, PMMR, and full forensic autopsy, were reviewed in our database retrospectively. Exclusion criteria were gas accumulations in the myocardial wall and cardiac trauma. LVWT on PMCT and PMMR was assessed. The measurements were repeated by the same rater after 2 months. Autopsy reports were reviewed, and LVWT and pericardial fluid volume measured at autopsy were noted. Pericardial fluid volume >50 ml was determined positive for pericardial effusion. Results: A total of 113 cases were included in the study. Twelve cases had pericardial effusion. Intrarater reliability for imaging based LVWT was excellent. LVWT (free wall) was significantly larger on PMCT (18.3 mm) compared to PMMR (17.6 mm), but these measurements correlated positively. LVWT (anterior wall) was significantly larger on PMMR (15 mm) than at autopsy (14 mm), and these measurements also correlated positively. Pericardial effusions led to larger differences between PMMR and autopsy measurements, however without statistical significance. Discussion: There exist discrepancies between LVWT as measured on postmortem imaging and at autopsy. Specialists should be aware in order to not misinterpret imaging measurements