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Chen Z, Zhang C, Liu C, Xiao X, Lai X, Wang Y, Zhu G, Lv J, Wang D, Yu X. Hepatic venous gas secondary to pulmonary barotrauma: rat model study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00755-7. [PMID: 38147284 DOI: 10.1007/s12024-023-00755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
Intrahepatic gas (IHG) is commonly observed during early postmortem examinations of humans with upper or lower airway obstructions. We conducted a study to test the hypothesis that intrapulmonary gas could retrogradely spread to the hepatic vein following pulmonary barotrauma (PB). To establish a rat model of pulmonary barotrauma, we utilized a controllable pressure-vacuum pump to apply airway pressure (40, 60, or 80 mmHg). The rats were dissected directly at the end of the experiment, and histological analysis was performed through microscopic examination of the rats. Additionally, the rats were ventilated with meglumine diatrizoate under pressures of 160 and 250 mmHg to observe the signal dynamic diffusion using X-ray fluoroscopy examination. Rats exhibited classical changes associated with PB, such as alveolar rupture, pulmonary interstitial emphysema, and hemorrhage, as well as IHG characterized by the presence of gas in the hepatic vein and hepatic sinusoids. Air emboli were not observed in the liver in any of the 40 mmHg groups. However, they were observed in the liver in the 60 and 80 mmHg groups, the amount and size of air emboli in the 80 mmHg group were greater than those in the 60 mmHg group (p < 0.05). The 80 mmHg group presented radial grape-like bubbles in the centrilobular portion of the liver accompanied by congestion in the peripheral region of the hepatic lobule. X-ray fluoroscopy examination revealed a gradual enhancement of dynamic contrast medium signals from the lung to the inferior vena cava and then to the liver. Our findings indicate that pulmonary barotrauma can lead to the retrograde spread of intrapulmonary gas to the hepatic vein. When it is clear that no decomposition of the body has occurred, the presence of IHG serves as a novel indicator for the diagnosis of obstructive pulmonary disease or obstruction in the upper or lower airway.
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Affiliation(s)
- Zeyu Chen
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Chuanqi Zhang
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
- Department of Laboratory Medicine, Urban Vocational College of Sichuan, Chengdu, Sichuan Province, 610110, People's Republic of China
| | - Chao Liu
- Jinjiang Public Security Bureau, Jinjiang, Fujian Province, 362200, People's Republic of China
| | - Xudong Xiao
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Xiaoping Lai
- Guangdong Medical University, Guangzhou, Guangdong Province, 523808, People's Republic of China
| | - Yu Wang
- Fujian Mingjian Forensic Institute, Jinjiang, Fujian Province, 362200, People's Republic of China
| | - Guanghui Zhu
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Junyao Lv
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Dian Wang
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Xiaojun Yu
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China.
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Wu W, Guo BB, Zhang JG, Wang RS, Ruan HB, Liu L. Forensic Identification of Diving Deaths. FA YI XUE ZA ZHI 2021; 37:683-686. [PMID: 35187921 DOI: 10.12116/j.issn.1004-5619.2020.400501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Investigation of the cause of death during diving is one of the contents of forensic pathology. In this article, relevant foreign literature is reviewed to summarize the techniques and methods used in the identification of diving deaths, such as accident reconstruction, diving monitoring data, postmortem CT examination and gas analysis (location and quantity) in the body of the corpse, in order to provide a reference for forensic identification of such cases.
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Affiliation(s)
- Wei Wu
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Bing-Bing Guo
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Jing-Guo Zhang
- Chaoyang District Sub-bureau, Public Security Bureau of Beijing, Beijing 100025, China
| | - Rong-Shuai Wang
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Hong-Bin Ruan
- Hubei Chongxin Judicial Expertise Center, Wuhan 430415, China
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
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Correlation between blood gas analysis and cardiac gas on immediate postmortem computed tomography after cardiopulmonary resuscitation. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions. Forensic Sci Med Pathol 2020; 16:3-11. [PMID: 31463781 PMCID: PMC7069893 DOI: 10.1007/s12024-019-00162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0–48 days) and 0.01 day (0–1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.
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Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies. Radiol Med 2019; 124:1018-1027. [PMID: 31254219 DOI: 10.1007/s11547-019-01052-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. MATERIALS AND METHODS This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. RESULTS The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. CONCLUSION Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes.
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Wagensveld IM, Blokker BM, Wielopolski PA, Renken NS, Krestin GP, Hunink MG, Oosterhuis JW, Weustink AC. Total-body CT and MR features of postmortem change in in-hospital deaths. PLoS One 2017; 12:e0185115. [PMID: 28953923 PMCID: PMC5617178 DOI: 10.1371/journal.pone.0185115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the frequency of total-body CT and MR features of postmortem change in in-hospital deaths. MATERIALS AND METHODS In this prospective blinded cross-sectional study, in-hospital deceased adult patients underwent total-body postmortem CT and MR followed by image-guided biopsies. The presence of PMCT and PMMR features related to postmortem change was scored retrospectively and correlated with postmortem time interval, post-resuscitation status and intensive care unit (ICU) admittance. RESULTS Intravascular air, pleural effusion, periportal edema, and distended intestines occurred more frequently in patients who were resuscitated compared to those who were not. Postmortem clotting was seen less often in resuscitated patients (p = 0.002). Distended intestines and loss of grey-white matter differentiation in the brain showed a significant correlation with postmortem time interval (p = 0.001, p<0.001). Hyperdense cerebral vessels, intravenous clotting, subcutaneous edema, fluid in the abdomen and internal livores of the liver were seen more in ICU patients. Longer postmortem time interval led to a significant increase in decomposition related changes (p = 0.026). CONCLUSIONS There is a wide variety of imaging features of postmortem change in in-hospital deaths. These imaging features vary among clinical conditions, increase with longer postmortem time interval and must be distinguished from pathologic changes.
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Affiliation(s)
- Ivo M. Wagensveld
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- * E-mail:
| | - Britt M. Blokker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Piotr A. Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Nomdo S. Renken
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, Zuid-Holland, The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Myriam G. Hunink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - J. Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Annick C. Weustink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
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Postmortem CT is more accurate than clinical diagnosis for identifying the immediate cause of death in hospitalized patients: a prospective autopsy-based study. Virchows Arch 2016; 469:101-9. [PMID: 27085336 PMCID: PMC4923108 DOI: 10.1007/s00428-016-1937-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/04/2016] [Accepted: 03/29/2016] [Indexed: 10/25/2022]
Abstract
Despite 75 to 90 % physician accuracy in determining the underlying cause of death, precision of determination of the immediate cause of death is approximately 40 %. In contrast, two thirds of immediate causes of death in hospitalized patients are correctly diagnosed by postmortem computed tomography (CT). Postmortem CT might provide an alternative approach to verifying the immediate cause of death. To evaluate the effectiveness of postmortem CT as an alternative method to determine the immediate cause of death in hospitalized patients, an autopsy-based prospective study was performed. Of 563 deaths from September 2011 to August 2013, 50 consecutive cadavers undergoing hospital autopsies with consent for additional postmortem CT at the University of Fukui were enrolled. The accuracy of determination of the immediate cause of death by postmortem CT was evaluated in these patients. Diagnostic discrepancy was also compared between radiologists and attending physicians. The immediate cause of death was correctly diagnosed in 37 of 50 subjects using postmortem CT (74 %), concerning 29 cases of respiratory failure, 4 of hemorrhage, 3 of liver failure and 1 of septic shock. Six cases of organ failure involving 13 patients were not identified as the cause of death by postmortem CT. Regarding the immediate cause of death, accuracy of clinical diagnosis was significantly lower than that of postmortem CT (46 vs 74 %, P < 0.01). Postmortem CT may be more useful than clinical diagnosis for identifying the immediate cause of death in hospitalized patients not undergoing autopsy.
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Sugimoto M, Hyodoh H, Rokukawa M, Kanazawa A, Murakami R, Shimizu J, Okazaki S, Mizuo K, Watanabe S. Freezing effect on brain density in postmortem CT. Leg Med (Tokyo) 2015; 18:62-5. [PMID: 26832379 DOI: 10.1016/j.legalmed.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
Abstract
Two 60-year-old males were found at their homes whose bodies had deteriorated due to putrefaction. To prevent worm invasion and minimize deterioration, dry ice was used prior to the autopsy investigation. Prior to autopsy, postmortem CT demonstrated a decreased density in brain parenchyma at the dry-iced side, and autopsy revealed deteriorated brain parenchyma with frozen effect (presented like sherbet). Moreover, the deteriorated cerebral parenchyma maintained their structure and they were evaluated by cutting. When lower CT density presents in postmortem CT, the freezing effect may need to be considered and the physician should evaluate the cadaver's postmortem condition to prevent misdiagnoses.
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Affiliation(s)
- Miyu Sugimoto
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Hideki Hyodoh
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan.
| | - Masumi Rokukawa
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Ayumi Kanazawa
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Rina Murakami
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Junya Shimizu
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Shunichiro Okazaki
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Keisuke Mizuo
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
| | - Satoshi Watanabe
- Department of Legal Medicine, Sapporo Medical University, S1 W17 Chuo-ku, Sapporo 060-8556, Japan
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Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K. Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions. Korean J Radiol 2015; 16:798-809. [PMID: 26175579 PMCID: PMC4499544 DOI: 10.3348/kjr.2015.16.4.798] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Masanori Ishida
- 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
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hidemi Okuma
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukako Shintani
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yutaka Takazawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Halbertsma FJJ, Mohns T, Bok LA, Niemarkt HJ, Kramer BW. Prevalence of systemic air-embolism after prolonged cardiopulmonary resuscitation in newborns: A pilot study. Resuscitation 2015; 93:96-101. [PMID: 26092516 DOI: 10.1016/j.resuscitation.2015.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chest compressions (CC) during cardiopulmonary resuscitation (CPR) are the cornerstone of adult CPR protocols and are meant to restore circulation and improve outcome. Although adverse effects such as air-embolisms have been reported, these are rare and considered to be outweighed by beneficial effect. In newborns, however, the lung tissue is more fragile. Thus, the high intra-thoracic pressures resulting from CC may make the newborns more vulnerable for air-embolisms. OBJECTIVES We studied the postmortem prevalence of air-embolism in neonates that have received CPR. METHODS Prospective cohort analysis of newborns receiving CC during CPR. CPR was performed by trained staff according to ILCOR guidelines, in a tertiary hospital. Air-embolisms were sought after using CT/MRI and autopsy. RESULTS During a 61/2 year period (2007-2014), n = 56 newborns received CC. Newborns were resuscitated following severe perinatal hypoxia, or due to complications during NICU treatment. In n = 14 (25.0%) circulation could not be restored (mean CPR duration: 32.7 ± 15.2 min). Post-mortem CT/MRI was performed in n = 9, of whom n = 8 (88.9%) had air-embolisms. Autopsy was performed in n = 9. The air-embolisms could not be retraced on autopsy except for n = 1 patient. In patients with CPR resulting in restored circulation (n = 42), no CT or MRI was performed for comparison due to radiation and/or hemodynamic instability. Cerebral ultrasound could not identify or exclude air-embolisms in this subgroup. CONCLUSIONS Post-mortem CT after prolonged resuscitation showed a high prevalence of intravascular air-embolism. Autopsy was not suited to detect air-embolism. The clinical importance of air-embolisms on the lethal outcome needs further research.
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Affiliation(s)
| | - Thilo Mohns
- Maxima Medical Centre, Dept. Neonatal ICU, Veldhoven, The Netherlands
| | - Levinus A Bok
- Maxima Medical Centre, Dept. Neonatal ICU, Veldhoven, The Netherlands
| | | | - Boris W Kramer
- Maastricht University Medical Centre, Maastricht, The Netherlands
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Postmortem CT Appearance of Gas Collections in Fatal Diving Accidents. AJR Am J Roentgenol 2014; 203:468-75. [DOI: 10.2214/ajr.13.12063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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High-resolution 3D-MRI of postmortem brain specimens fixed by formalin and gadoteridol. Leg Med (Tokyo) 2014; 16:218-21. [DOI: 10.1016/j.legalmed.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 11/24/2022]
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Recent modifications to the investigation of diving related deaths. Forensic Sci Med Pathol 2013; 10:83-90. [PMID: 24166195 DOI: 10.1007/s12024-013-9491-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
The investigation of deaths that involve diving using a compressed breathing gas (SCUBA diving) is a specialized area of forensic pathology. Diving related deaths occur more frequently in certain jurisdictions, but any medical examiner or coroner's office may be faced with performing this type of investigation. In order to arrive at the correct conclusion regarding the cause and manner of death, forensic pathologists and investigators need to have a basic understanding of diving physiology, and should also utilize more recently developed technology and ancillary techniques. In the majority of diving related deaths, the cause of death is drowning, but this more often represents a final common pathway due to a water environment. The chain of events leading to the death is just as important to elucidate if similar deaths are to be minimized in the future. Re-enactment of accident scenarios, interrogation of dive computers, postmortem radiographic imaging, and slight alterations in autopsy technique may allow some of these diving related deaths to the better characterized. The amount and location of gas present in the body at the time of autopsy may be very meaningful or may simply represent a postmortem artifact. Medical examiners, coroners, and forensic investigators should consider employing select ancillary techniques to more thoroughly investigate the factors contributing a death associated with SCUBA diving.
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Berger N, Ross SG, Ampanozi G, Majcen R, Schweitzer W, Gascho D, Thali MJ, Flach PM. Puzzling over intracranial gas: Disclosing a pitfall on postmortem computed tomography in a case of fatal blunt trauma. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jofri.2013.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Okuda T, Shiotani S, Kobayashi T, Kohno M, Hayakawa H, Kikuchi K, Suwa K. Immediate non-traumatic postmortem computed tomographic demonstration of myocardial intravascular gas of the left ventricle: effects from cardiopulmonary resuscitation. SPRINGERPLUS 2013; 2:86. [PMID: 23519017 PMCID: PMC3599202 DOI: 10.1186/2193-1801-2-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/20/2013] [Indexed: 11/10/2022]
Abstract
An 87-year-old man was found in a state of cardiopulmonary arrest. Despite cardiopulmonary resuscitation (CPR) for over 1 hour by emergency technicians and physicians, the patient died. Immediate postmortem computed tomography showed cardiovascular gas in the right atrium, right ventricle, and left ventricle. Cardiovascular gas in the left ventricle was located in the myocardium and appeared as linear or branch-shaped suggesting the presence of myocardial intravascular gas. This is the first report describing the appearance and significance of myocardial intravascular gas of the left ventricle as a CPR-related change.
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Affiliation(s)
- Takahisa Okuda
- Department of Legal Medicine, Nippon Medical School, Tokyo, Japan ; Tsukuba Medical Examiner's Office, Tsukuba, Japan
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Postmortem CT investigation of air/gas distribution in the lungs and gastrointestinal tracts of newborn infants: A serial case study with regard to still- and live birth. Forensic Sci Int 2013; 226:74-80. [DOI: 10.1016/j.forsciint.2012.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 10/12/2012] [Accepted: 12/02/2012] [Indexed: 11/22/2022]
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Gebhart FTF, Brogdon BG, Zech WD, Thali MJ, Germerott T. Gas at postmortem computed tomography--an evaluation of 73 non-putrefied trauma and non-trauma cases. Forensic Sci Int 2012; 222:162-9. [PMID: 22721934 DOI: 10.1016/j.forsciint.2012.05.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 05/04/2012] [Accepted: 05/17/2012] [Indexed: 01/05/2023]
Abstract
Postmortem computed tomography (PMCT) has become an important complement in investigating forensic cases allowing an accurate detection of gas accumulations. The present study investigated the presence and distribution of gas in a large number of non-putrefied cases of traumatic and non-traumatic deaths. Furthermore the possibility of pneumobilia secondary to blunt abdominal trauma was studied. Retrospectively, 73 cases, underwent a whole-body PMCT prior to autopsy. These were divided into four groups: penetrating trauma (20 gunshot cases, 13 stabbing cases), blunt abdominal trauma (20 cases) and a control group of 20 non-trauma cases. Exclusion criteria were visible signs of decomposition. Each group was screened for gas accumulations in the vascular system, internal organs, soft tissues and body cavities. Gas accumulations were present in 98% of the trauma cases, compared to 80% of the control group. The most affected structures and/or organs in the trauma group were soft tissues, vessels and the liver. In most cases of the trauma group gas was associated with open injuries and lacerations of vessels. Furthermore, in the gunshot group gas was frequently seen in the intracranial cavity. Pneumobilia occurred in one case of the blunt trauma group; in that control group gas was also seen, but less frequently. Gas accumulation showed a strong association with traumatic events, but even the majority of non-trauma cases showed gas accumulations. Despite the exclusion of cases with visible decomposition signs, a putrefactive origin of gas was assumed in some cases. Gas accumulations are a frequent finding in PMCT with a higher incidence in (open) trauma cases. Even though a differentiation between putrefactive and traumatic gas accumulations is still difficult, knowledge of the circumstance surrounding the case may help identify the origin of gas.
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Affiliation(s)
- Florin T F Gebhart
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Bern, Bern, Switzerland.
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Background and current status of postmortem imaging in Japan: short history of "Autopsy imaging (Ai)". Forensic Sci Int 2012; 225:3-8. [PMID: 22480884 DOI: 10.1016/j.forsciint.2012.03.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 11/24/2022]
Abstract
There is a low autopsy rate and wide distribution of computed tomography (CT) and magnetic resonance imaging (MRI) scanners in Japan. Therefore, many Japanese hospitals, including 36% of the hospitals with in-patient facilities and 89% of large hospitals with ER facilities conduct postmortem imaging (PMI), use clinical scanners to screen for causes in unusual deaths as an alternative to an autopsy or to determine whether an autopsy is needed. The Japanese PMI examination procedure is generally referred to as "autopsy imaging" (Ai) and the term "Ai" is now commonly used by the Japanese government. Currently, 26 of 47 Japanese prefectures have at least one Ai Center with scanners that are dedicated for PMI. Here, we briefly review the history of Japanese PMI (Ai) from 1985 to the present.
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Laurent PE, Coulange M, Bartoli C, Boussuges A, Rostain JC, Luciano M, Cohen F, Rolland PH, Mancini J, Piercecchi MD, Vidal V, Gorincour G. Appearance of gas collections after scuba diving death: a computed tomography study in a porcine model. Int J Legal Med 2011; 127:177-84. [PMID: 22207142 DOI: 10.1007/s00414-011-0662-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 12/14/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postmortem computed tomography can easily demonstrate gas collections after diving accidents. Thus, it is often used to support the diagnosis of air embolism secondary to barotrauma. However, many other phenomenons (putrefaction, resuscitation maneuvers, and postmortem tissue offgassing) can also cause postmortem gas effusions and lead to a wrong diagnosis of barotrauma. OBJECTIVES The aim of this study is to determine topography and time of onset of postmortem gas collections respectively due to putrefaction, resuscitation maneuvers, and tissue offgassing. MATERIALS AND METHODS A controlled experimental study was conducted on nine pigs. Three groups of three pigs were studied postmortem by CT from H0 to H24: one control group of nonresuscitated nondivers, one group of divers exposed premortem to an absolute maximal pressure of 5 b for 16 min followed by decompression procedures, and one group of nondivers resuscitated by manual ventilation and thoracic compression for 20 min. The study of intravascular gas was conducted using CT scan and correlated with the results of the autopsy. RESULTS The CT scan reveals that, starting 3 h after death, a substantial amount of gas is observed in the venous and arterial systems in the group of divers. Arterial gas appears 24 h after death for the resuscitated group and is absent for the first 24 h for the control group. Concerning the putrefaction gas, this provokes intravenous and portal gas collections starting 6 h after death. Subcutaneous emphysema was observed in two of the three animals from the resuscitated group, corresponding to the thoracic compression areas. CONCLUSION In fatal scuba diving accidents, offgassing appears early (starting from the first hour after death) in the venous system then spreads to the arterial system after about 3 h. The presence of intra-arterial gas is therefore not specific to barotrauma. To affirm a death by barotrauma followed by a gas embolism, a postmortem scanner should be conducted very early. Subcutaneous emphysema should not be mistaken as diagnostic criteria of barotrauma because it can be caused by the resuscitation maneuvers.
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Affiliation(s)
- Pierre-Eloi Laurent
- Aix-Marseille Université, Faculté de Médecine, Laboratoire de Physiopathologie et Thérapeutique Vasculaire (L2PTV), Marseille, France.
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Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments. Jpn J Radiol 2011; 29:701-6. [DOI: 10.1007/s11604-011-0618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/09/2011] [Indexed: 10/16/2022]
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Ishida M, Gonoi W, Hagiwara K, Takazawa Y, Akahane M, Fukayama M, Ohtomo K. Intravascular gas distribution in the upper abdomen of non-traumatic in-hospital death cases on postmortem computed tomography. Leg Med (Tokyo) 2011; 13:174-9. [PMID: 21561795 DOI: 10.1016/j.legalmed.2011.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/14/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the occurrence of intravascular gas in the liver, kidneys, spleen, and pancreas by postmortem computed tomography (PMCT) in cases of non-traumatic in-hospital deaths and elucidate the relationship between the PMCT data and clinical information or autopsy results. METHODS The study included 45 cadavers of patients who died while receiving treatment in our academic tertiary-care hospital between April and December 2009. All subjects underwent PMCT and conventional autopsy. The appearance of postmortem gas in the liver, kidney, spleen, and pancreas was assessed using PMCT and scored using a subjective scale (liver, L0-L3; kidney, K0-K2; spleen, S0-S1; and pancreas, P0-P1), and the distribution of gases in the vessels of the liver (arteries, veins, and portal veins) was analyzed. The relationship between the gas score and time elapsed since death, cardiopulmonary resuscitation (CPR), administration of antibiotics, a history of bacteremia, or cause of death was assessed statistically. RESULTS Positive correlations were found between administration of CPR and liver and kidney gas scores (P=0.008 and 0.002, respectively), but not with spleen and pancreas gas (P=0.291 and 0.535, respectively). No significant relationship between distribution of gas in the vessels of the liver and CPR was found. No other significant correlations between gas and any of the other parameters described above were found. While significant correlations were detected in no-CPR cases between liver gas, kidney gas, spleen gas, and pancreas gas (P<0.001 for all six combinations), no correlation between these parameters was detected in the CPR cases. CONCLUSIONS The present study was the first statistical analysis of intravascular gas in the liver, kidneys, spleen, and pancreas by using PMCT in non-traumatic in-hospital death cases. The results showed that PMCT in the presence and absence of CPR reveals differences in intraorgan gas distribution. In addition, the detection of intraorgan gas on PMCT cannot be used to predict time elapsed since death, and it is not affected by the administration of antibiotics, a history of bacteremia, and cause of death. Awareness of these postmortem changes is important for the accurate interpretation of PMCT results.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Zenda T, Takayama T, Miyamoto M, Yamaguchi S, Endo T, Inaba H. Intravascular gas in multiple organs detected by postmortem computed tomography: effect of prolonged cardiopulmonary resuscitation on organ damage in patients with cardiopulmonary arrest. Jpn J Radiol 2011; 29:148-51. [PMID: 21359941 DOI: 10.1007/s11604-010-0511-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/27/2010] [Indexed: 11/28/2022]
Abstract
A 76-year-old woman was found in cardiopulmonary arrest with her head submerged in water in a bathtub. Despite cardiopulmonary resuscitation (CPR) for over 1 h by professional emergency technicians and medical doctors, the patient died. Postmortem computed tomography revealed not only pulmonary edema associated with drowning but also the presence of intravascular gas in the pulmonary artery, liver, kidneys, heart (right ventricle), and brain. It was speculated that intravascular gas was generated and spread to multiple organs during CPR procedures via the alimentary tract and lungs, which had been damaged by ischemia after cardiopulmonary arrest. Prolonged CPR procedures may involve the risk of additional organ damage and systemic air emboli.
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Affiliation(s)
- Takahiro Zenda
- Department of Internal Medicine, Tsurugi Municipal Hospital, Hakusan, Japan.
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Kobayashi T, Isobe T, Shiotani S, Saito H, Saotome K, Kaga K, Miyamoto K, Kikuchi K, Hayakawa H, Akutsu H, Homma K. Postmortem magnetic resonance imaging dealing with low temperature objects. Magn Reson Med Sci 2011; 9:101-8. [PMID: 20885082 DOI: 10.2463/mrms.9.101] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In Japan, the medical examiner system is not widespread, the rate of autopsy is low, and many medical institutions therefore perform postmortem imaging using clinical equipment. Postmortem imaging is performed to clarify cause of death, select candidates for autopsy, make a guide map for autopsy, or provide additional information for autopsy. Findings are classified into 3 categories: cause of death and associated changes, changes induced by cardiopulmonary resuscitation, and postmortem changes. Postmortem magnetic resonance imaging shows characteristic changes in signal intensity related to low body temperature after death; they are low temperature images.
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Affiliation(s)
- Tomoya Kobayashi
- Department of Radiological Technology, Tsukuba Medical Center, Tsukuba, Ibaraki, Japan.
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