Abstract
We commend Guy Rutty and colleagues on their Article (July 8, p 145)1Rutty GN Morgan B Robinson C et al.Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study.Lancet. 2017; 390: 145-154Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar recommending the use of post-mortem imaging at autopsy. A fundamental role of the pathologist is to assist the coroner in fulfilling their statutory duty in establishing the cause and circumstances of death. How precise that cause of death needs to be depends on the requirements of the relevant legislation. To what extent pathology and radiology can satisfactorily provide the information to inform this advice depends on the circumstances of the case and, most importantly, on the questions being asked by interested parties, including families. In the state of Victoria, Australia, the coroner can discontinue an investigation if advised by a pathologist that death was likely to be due to natural causes, a conclusion often suggested in the first instance by the circumstances and arrived at by the absence of suspicious external examination or radiological findings and negative toxicology results. Atheromatous narrowing of the coronary arteries is a chronic condition that is commonly encountered and, in the absence of other pathological processes, trauma, or concerning circumstances, is frequently and reasonably considered to be the underlying cause of natural death. Even without the benefit of an autopsy or CT scan, in the elderly population, this deduction will often be correct, simply because of the prevalence of this condition. In conclusion, we concur with the authors' view that pathology and radiology are complementary diagnostic modalities, but whether either or both can provide any or all the answers depends on what the questions are and on the context of the case. We declare no competing interests. Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison studyFor most sudden natural adult deaths investigated by HM Coroners, PMCTA could be used to avoid invasive autopsy. The gold standard of post-mortem investigations should include both PMCT and invasive autopsy. Full-Text PDF Open Access
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have