The common pattern of postmortem changes on whole body CT scans

Klein, Willemijn M.; Kunz, T.; Hermans, Kelly; Bayat, Ali; Koopmanschap, Desirée H. J. L. M.

doi:10.1016/j.jofri.2015.11.006

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…Resuscitation induced changes and normal postmortem changes, such as the occurrence of pulmonary oedema, could mask pneumonia ( figure 5 ). 17 In the subgroup of perfusion disorders, diagnosis of pulmonary embolism at unenhanced PMCT is challenging as it is notoriously difficult to distinguish an antemortem thrombus from a postmortem blood clot. 18–20 This, or the possibility that the embolus was lost during the autopsy procedure, may explain why in three cases the pulmonary embolism was not confirmed during autopsy.…”

Section: Discussionmentioning

confidence: 99%

Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre

et al. 2018

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ObjectiveTo investigate whether virtual autopsy with postmortem CT (PMCT) improves clinical diagnosis of the immediate cause of death.DesignRetrospective observational cohort study. Inclusion criteria: inhospital and out-of-hospital deaths over the age of 1 year in whom virtual autopsy with PMCT and conventional autopsy were performed. Exclusion criteria: forensic cases, postmortal organ donors and cases with incomplete scanning procedures. Cadavers were examined by virtual autopsy with PMCT prior to conventional autopsy. The clinically determined cause of death was recorded before virtual autopsy and was then adjusted with the findings of virtual autopsy. Using conventional autopsy as reference standard, we investigated the increase in sensitivity for immediate cause of death, type of pathology and anatomical system involved before and after virtual autopsy.SettingTertiary referral centre.Participants86 cadavers that underwent conventional and virtual autopsy between July 2012 and June 2016.InterventionPMCT consisted of brain, cervical spine and chest–abdomen–pelvis imaging. Conventional autopsy consisted of thoracoabdominal examination with/without brain autopsy.Primary and secondary outcome measuresIncrease in sensitivity for the immediate cause of death, type of pathology (infection, haemorrhage, perfusion disorder, other or not assigned) and anatomical system (pulmonary, cardiovascular, gastrointestinal, other or not assigned) involved, before and after virtual autopsy.ResultsUsing PMCT, the sensitivity for immediate cause of death increased with 12% (95% CI 2% to 22%) from 53% (41% to 64%) to 64% (53% to 75%), with 18% (9% to 27%) from 65% (54% to 76%) to 83% (73% to 91%) for type of pathology and with 19% (9% to 30%) from 65% (54% to 76%) to 85% (75% to 92%) for anatomical system.ConclusionWhile unenhanced PMCT is an insufficient substitute for conventional autopsy, it can improve diagnosis of cause of death over clinical diagnosis alone and should therefore be considered whenever autopsy is not performed.

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Section: Discussionmentioning

confidence: 99%

Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre

et al. 2018

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“…Virtopsy using postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging (PMMRI) has been implemented in the pioneering virtopsydriven cetacean stranding response program in Hong Kong (HK) waters, to provide vital or additional information for conventional necropsy (Kot et al, 2016(Kot et al, , 2018(Kot et al, , 2019(Kot et al, , 2020Chan et al, 2017;Yuen et al, 2017). Stranded cetacean carcasses found in HK waters are often badly degraded (Jefferson et al, 2002) as high temperature and humidity accelerate autolysis (Klein et al, 2016), hampering stranding response personnel and veterinarians in the documentation of postmortem findings and tissue sampling (Tsui et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

et al. 2020

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Postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging (PMMRI) have been applied to provide vital or additional information for conventional necropsy, along the pioneering virtopsy-driven cetacean stranding response program in Hong Kong waters. It is common for stranded carcasses to become badly degraded and susceptible to rapid cerebral autolysis and putrefaction. Necropsy on decomposed brains with limited sample analysis often defy a specific diagnosis. Studies on PMMR neuroimaging have focused on neuroanatomy and brain morphology in freshly deceased or preserved specimens. Moreover, the literature is devoid of any reference on the potential value of PMMRI examination of decomposed cetacean brains. To that end, this project evaluated the benefits of PMMR neuroimaging in situ in decomposed carcasses in comparison to PMCT. A total of 18 cetacean carcasses were studied by PMCT and PMMRI examinations. Anatomical brain structures and visible brain pathologies were evaluated and scored using Likert-scale rating. Intracranial gas accumulation was clearly depicted in all cases by all radiological techniques. Other features were more clearly depictable in PMMRI than in PMCT images. Results of this study indicated that superiority of PMMRI compared to PMCT increased with advanced putrefaction of the brain. The preservation of structural integrity was presented by PMMRI due to its superior capability to evaluate soft tissue. Brain PMMRI should be incorporated in postmortem investigation of decomposed stranded cetaceans.

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“…Normal postmortem changes could have influenced the attenuation values of the liver on CT. It is known that the liver decreases in size after death probably through the sedimentation of blood to the depending part of the body (livor mortis) [19]. Therefore it is likely that the attenuation values of the liver change after death, consistent with the changing attenuation values of the spleen postmortem [20].…”

Section: Discussionmentioning

confidence: 83%

Pseudolesion in the right parafissural liver parenchyma on CT: the base is found in embryology and collagen content

Klein

Sonnemans

Franckenberg

et al. 2019

Preprint

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Background: Computed tomography (CT) images of livers may show a hypoattenuated structure alongside the falciform ligament, which can be a focal fatty pseudolesion and can mimic a malignancy. The preferred location is on the right parafissural site, ventral in segment IVa/b. The etiology is not clear, nor is it known how the histology of this location develops. These are evaluated in this study.Methods: 40 adult cadavers with autopsy and / or postmortem CT in a university hospital and a forensic center were included. Liver biopsies were taken at the left side of the falciform ligament as control, and at the right side as the possible precursor of a pseudolesion; these were examined for collagen and fat content. 3 Cadavers with steatotic (>5% fat) or fibrotic (>2% collagen) control samples were excluded. Results: Significantly more collagen was present in the right parafissural liver parenchyma: median 0.68% (IQR: 0.32 -1.17%), compared to the left side 0.48% (IQR: 0.21 -0.75%) (p 0.008), with equal fat content and CT attenuation values. The etiophysiology goes back to the demise of the umbilical venes in the early embryonic and neonatal period. Conclusions: The right parafissural area contains more collagen and an equal amount of fat compared to the control left side. This supports the hypothesis of delayed, 'third' inflow: the postnatal change in blood supply from umbilical to portal leaves the downstream parafissural area hypoperfused leading to hypoxia which in turn results in collagen accumulation and the persistence of paraumbilical veins of Sappey. Key points 1. The typical location for a parafissural hepatic pseudolesion contains increased collagen. 2. A change in histology is caused by physiological demise of the umbilical venes. 4 3. The suboptimal blood supply of the right parafissural side leads to hypoxia and collagen deposition. 4. Embryologic knowledge and postmortem histology can help resolve issues in radiology.

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The common pattern of postmortem changes on whole body CT scans

Cited by 13 publications

References 11 publications

Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre

Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre

Postmortem Neuroimaging of Cetacean Brains Using Computed Tomography and Magnetic Resonance Imaging

Pseudolesion in the right parafissural liver parenchyma on CT: the base is found in embryology and collagen content

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