When gas analysis assists with postmortem imaging to diagnose causes of death

Varlet, Vincent; Smith, Fiona; Giuliani, N.; Egger, Caroline; Rinaldi, A; Domínguez, Alejandro; Chevallier, Coralie; Bruguier, Christine; Augsburger, Marc; Mangin, Patrice; Grabherr, Silke

doi:10.1016/j.forsciint.2015.03.010

Cited by 33 publications

(25 citation statements)

References 22 publications

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“…The results of these studies are not clear-cut. Some authors emphasize the fact that the majority of post-mortem gas is the result of decomposition and should be treated as an artifact [26], even if there is no evidence of ongoing putrefaction [27]. Other authors highlight the fact that their studies did not confirm the decompositional origin of the gas visible in PMCT [28], especially when the CT scan was performed in the first 24 h after death.…”

Section: Discussionmentioning

confidence: 99%

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

Borowska-Solonynko

Koczyk

Blacha

et al. 2019

Forensic Sci Med Pathol

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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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Section: Discussionmentioning

confidence: 99%

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

Borowska-Solonynko

Koczyk

Blacha

et al. 2019

Forensic Sci Med Pathol

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“…A more effective gas sampling protocol based on Luer-Lock syringes equipped with three-way valve or introducing volatile compounds into gas-tight sealed vials containing stabilized water was recently published and its use is strongly supported for future cases [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Volatile lipophilic substances management in case of fatal sniffing

Romolo

Luca

Ciallella

et al. 2017

Journal of Forensic and Legal Medicine

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“…Beside liquid samples for toxicology, microbiology etc., and histological samples, gas can be sampled from the body in order to allow analysis of its composition [37]. This can be useful to differentiate vital air embolism from postmortem gas collections [38] or to investigate scuba diving accidents [39]. Extensive protocols for obtaining different samples are available in cases when PMA should be performed [5].…”

Section: Postmortem Tissue Samplingmentioning

confidence: 99%

Postmortem imaging as a complementary tool for the investigation of cardiac death

Michaud

Genet

Sabatasso

et al. 2019

Forensic Sciences Research

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In the past 2 decades, modern radiological methods, such as multiple detector computed tomography (MDCT), MDCT-angiography, and cardiac magnetic resonance imaging (MRI) were introduced into postmortem practice for investigation of sudden death (SD), including cases of sudden cardiac death (SCD). In forensic cases, the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause. There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques. This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination, especially in cases of SCD. In SCD cases, postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves, as well as to identify and locate cardiovascular devices. Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them, especially regarding the extent and location of stenosis and obstruction. In postsurgical cases, it allows verification and documentation of the patency of stents and bypass grafts before opening the body. Postmortem MRI is used to investigate soft tissues such as the myocardium, but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects, especially of the ischemic myocardium. In postsurgery cases, the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes. The implementation of new imaging methods into routine postmortem practice is challenging, as it requires not only an investment in equipment but, more importantly, investment in the expertise of interpreting the images. Once those requirements are implemented, however, they bring great advantages in investigating cases of SCD, as they allow documentation of the body, orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography. KEY POINTSThere are no established guidelines for the interpretation of postmortem imaging examination of the heart At present, postmortem imaging methods are considered as less accurate than the autopsy for cardiac deaths Postmortem imaging is useful as a complementary tool for cardiac deaths There is still a need to validate postmortem imaging in cardiac deaths by comparing with autopsy findings ARTICLE HISTORY

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When gas analysis assists with postmortem imaging to diagnose causes of death

Cited by 33 publications

References 22 publications

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

Volatile lipophilic substances management in case of fatal sniffing

Postmortem imaging as a complementary tool for the investigation of cardiac death

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