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

Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K - Korean J Radiol (2015)

Bottom Line: Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. ; Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, Tokyo 101-8326, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

Hypostasis and pathologic lesion in lung in 73-year-old deceased man (case 7).A. CT scan obtained 16 hours and 48 minutes after death shows increased density lesion with horizontal border in dependent region of left upper lobe, which is attributed to hypostasis (arrows). Endotracheal fluid, thought to be normal postmortem change, is also observed (arrowhead). B. Asymmetrical and segmental consolidation is simultaneously observed in right lower lobe (arrows). C, D. Pathological examination with hematoxylin and eosin on subsequent autopsy indicates pulmonary congestion (C; low-power view) and inflammatory cellular infiltration (pneumonia) (D; low-power view). Images C and D correspond to A and B, respectively. CT = computed tomography
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Figure 5: Hypostasis and pathologic lesion in lung in 73-year-old deceased man (case 7).A. CT scan obtained 16 hours and 48 minutes after death shows increased density lesion with horizontal border in dependent region of left upper lobe, which is attributed to hypostasis (arrows). Endotracheal fluid, thought to be normal postmortem change, is also observed (arrowhead). B. Asymmetrical and segmental consolidation is simultaneously observed in right lower lobe (arrows). C, D. Pathological examination with hematoxylin and eosin on subsequent autopsy indicates pulmonary congestion (C; low-power view) and inflammatory cellular infiltration (pneumonia) (D; low-power view). Images C and D correspond to A and B, respectively. CT = computed tomography

Mentions: In case 7, increased pulmonary density with a nearly horizontal border was observed in the dependent region of the bilateral upper lobes (Fig. 5A, arrows) and typifies postmortem lung hypostasis. This high pulmonary density on postmortem CT is characterized by a horizontal, gravity-dependent border and is often bilaterally symmetrical. In contrast, an asymmetrical and segmental increase in lung density on postmortem CT indicates a pathologic lesion and may be diagnosed in the same manner as on AMCT in daily practice. In this case, we suspected that the consolidation in right lower lobe was inflammation (Fig. 5B). Histopathologic examination and the autopsy confirmed these suspicions; pulmonary congestion (Fig. 5C) and inflammatory cellular infiltration (pneumonia) (Fig. 5D), corresponding to Figure 5A and B, respectively, were observed on microscopy. Endotracheal fluid was also observed (Fig. 5A, arrowhead). In our previous study, fluid within the airway was frequently observed on postmortem CT in subjects with pleural effusion or atelectasis/pulmonary consolidation, and the volume of airway fluid increased over time postmortem (17).


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

Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K - Korean J Radiol (2015)

Hypostasis and pathologic lesion in lung in 73-year-old deceased man (case 7).A. CT scan obtained 16 hours and 48 minutes after death shows increased density lesion with horizontal border in dependent region of left upper lobe, which is attributed to hypostasis (arrows). Endotracheal fluid, thought to be normal postmortem change, is also observed (arrowhead). B. Asymmetrical and segmental consolidation is simultaneously observed in right lower lobe (arrows). C, D. Pathological examination with hematoxylin and eosin on subsequent autopsy indicates pulmonary congestion (C; low-power view) and inflammatory cellular infiltration (pneumonia) (D; low-power view). Images C and D correspond to A and B, respectively. CT = computed tomography
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499544&req=5

Figure 5: Hypostasis and pathologic lesion in lung in 73-year-old deceased man (case 7).A. CT scan obtained 16 hours and 48 minutes after death shows increased density lesion with horizontal border in dependent region of left upper lobe, which is attributed to hypostasis (arrows). Endotracheal fluid, thought to be normal postmortem change, is also observed (arrowhead). B. Asymmetrical and segmental consolidation is simultaneously observed in right lower lobe (arrows). C, D. Pathological examination with hematoxylin and eosin on subsequent autopsy indicates pulmonary congestion (C; low-power view) and inflammatory cellular infiltration (pneumonia) (D; low-power view). Images C and D correspond to A and B, respectively. CT = computed tomography
Mentions: In case 7, increased pulmonary density with a nearly horizontal border was observed in the dependent region of the bilateral upper lobes (Fig. 5A, arrows) and typifies postmortem lung hypostasis. This high pulmonary density on postmortem CT is characterized by a horizontal, gravity-dependent border and is often bilaterally symmetrical. In contrast, an asymmetrical and segmental increase in lung density on postmortem CT indicates a pathologic lesion and may be diagnosed in the same manner as on AMCT in daily practice. In this case, we suspected that the consolidation in right lower lobe was inflammation (Fig. 5B). Histopathologic examination and the autopsy confirmed these suspicions; pulmonary congestion (Fig. 5C) and inflammatory cellular infiltration (pneumonia) (Fig. 5D), corresponding to Figure 5A and B, respectively, were observed on microscopy. Endotracheal fluid was also observed (Fig. 5A, arrowhead). In our previous study, fluid within the airway was frequently observed on postmortem CT in subjects with pleural effusion or atelectasis/pulmonary consolidation, and the volume of airway fluid increased over time postmortem (17).

Bottom Line: Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. ; Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, Tokyo 101-8326, Japan.

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.

No MeSH data available.


Related in: MedlinePlus