Correlation of postmortem pathological observations with chest roentgenograms.

Abstract

A correlation of postmortem pathological observations with roentgenograms of the chest provides the most factual information for the interpretation and diagnosis of thoracic lesions. Not infrequently the pathological and roentgen findings are at variance. These differences were observed to be due to the following causes: (1) Terminal pathological changes, i.e., changes occurring between the time the last film was taken and the patient's demise. Notable among the differences due to this cause is the variance in the amount of fluid in the pleural cavities. There was always more fluid postmortem whether the films had been obtained only a few hours or as long as forty-eight hours before death. Similar observations were made on other pathological conditions, as pneumonia, edema, atelectasis, etc. (2) Lack of characteristic roentgenologic differences between several pathological entities. (3) Inadequate portable roentgen equipment. The patients are sick, and the time factor for roentgenography is too long. (4) Last, but not least, associated pathological findings which may obscure the picture. The greatest offender in this respect is fluid. In view of these considerations, the importance of a good clinical history is obvious. In this paper we shall correlate the clinical features, the postmortem pathological findings, and the roentgen picture in pulmonary congestion, edema, embolism, infarction, pneumonia, and atelectasis. One of our primary objects is to determine how closely the x-ray findings and diagnosis agree with the postmortem study, and to ascertain causes of error. Most of the roentgenograms for the investigation were taken postmortem; a few antemortem films obtained within forty-eight hours of death are included. Procedure for Postmortem X-ray Examination When permission has been granted for an autopsy, a chest film is taken in the upright position at a distance of 60 inches. The method of suspending the body has been simplified so that one person can carry out the roentgenographic procedure. The autopsy is then performed in the regular fashion. Routinely the X-ray Department receives a copy of the gross and microscopic pathological report. The wrists of the patient are secured to the thighs by soft gauze loops. The body is supported by slings under the arms looped over the ends of a short metal bar on the mobile lower end of an overhead block-and-tackle system (Fig. 1). A soft gauze loop is placed around the head and supporting slings, so as to stabilize the head. The body is raised to a vertical position and the ropes of the block and tackle are secured to a cleat on the wall. The cassette is positioned in front of the chest by an adjustable hanger attached to the bar which supports the patient. The portable x-ray machine, which is a part of the morgue equipment, is then positioned accurately behind the patient and a postero-anterior exposure is made.