Daily application of post-mortem computed tomography digital autopsy in a public mortuary

Abstract

The digital autopsy has gained increasing attention in the past decade as post mortem computed tomography has become more widely available. Whether conducted with or without radiographic contrast, digital autopsies have been shown to be a valuable adjunct to invasive examinations in the investigation of natural and unnatural deaths. It has the potential to reduce the number of full invasive autopsies performed, allowing for more targeted limited invasive examinations. In certain deaths, the digital autopsy may obviate the need for an invasive examination entirely. This article considers the daily use of post mortem computed tomography in routine coronial autopsy practice in a busy public mortuary in England. The integration of the digital autopsy in to the investigation of natural deaths (including decomposing and embalmed bodies) is first considered before dealing with commonly encountered unnatural deaths due to surgery, industrial disease, trauma, drug overdose and suicides.

Noninvasive postmortem investigation of cases refusing autopsy using computed tomography

“…In this study, no direct evidence of perivascular hematoma is detected in all subjects. The hemopericardium is indirect evidence of ascending aortic or heart rupture that is frequently found in autopsy observation [6]. In this study, we can detect hemopercardium in five subjects.…”

“…Recently, several studies have proposed the use of PMCT to determine the cause of death [1][2][3][4][5][6][7][8][9][10]. The PMCT is considered the most feasible imaging modality because it is widely available.…”

“…The acute coronary syndrome is one of the commonest causes of death worldwide. The absence of post mortem coronary angiography may lead to underdiagnosis of an acute coronary syndrome [6]. The Agatston score measured in non-contrast CT more than 400 may indicate the likely presence of the significant coronary artery disease but it is not a definite diagnosis.…”

“…The pulmonary embolism is one the most common sudden deaths that is presented with cardiovascular collapse. However, the pulmonary embolism is limited for diagnosis in non-contrast PMCT [3,6].…”

Why Should Clinical Autopsies Continue to Exist?

“…One promising alternative is computed tomography (CT) images as an adjuvant in diagnosing the cause of death during an autopsy, a practice known as virtopsy [20]. Although still in its first decade, it is already clear that autopsy and CT are complementary examination modalities [21]. Images of fluid collections, hypertensive pneumothorax, cerebral hemorrhage, and even an acute aortic dissection followed by cardiac tamponade can be observed in the cadaver.…”