Post Mortem CT Scan: An Alternative Method In Forensic Medicine And Trauma Research

Abstract

In Israel, permission to conduct autopsy is very difficult to get. Postmortem CT PMCT scan allows a relatively quick diagnosis of causes for death. It also serves for quality assurance in trauma and trauma research. Seven cases of PMCT are demonstrated and discussed in this article. INTRODUCTION Since we have published our paper “Utility of postmortem computed tomography in trauma victims” (Donchin-Y; Rivkind-AI; Bar-Ziv-J; Hiss-J; Almog-J; Drescher-M JTrauma. 1994 Oct; 37(4): 552-5; ) we have performed more than 90 postmortem CT scans. We would like to present 7 cases to demonstrate the value of the postmortem CT scan PMCT . This method does not substitute formal necropsy, but if there is no other way to answer clinical question, like: PMCT can be done within a few minutes and there is no need to touch the body. It is the method of choice when there is no time for further diagnostics or when permission for autopsy cannot be obtained. The following cases serve as an illustration of the possibilities of PMCT diagnostic. CASE DESCRIPTIONS Case 1: A 30-year-old Male was killed in a snapping accident. Head CT in soft tissue window demonstrates pneumocephalus (figure a, curved arrow). Intra-ventricular hemorrhage is also noted (figure a, straight thin arrow). A metallic fragment is seen in the nasopharynx, representing a dislodged tooth fragment with an amalgam feeling (figure b, straight block arrow). Figure c is a lateral cervical film demonstrating the metallic fragment within the nasopharynx (block arrow) Figure 1 Post Mortem CT Scan: An Alternative Method In Forensic Medicine And Trauma Research 2 of 8 Figure 2 Figure 3 Case 2: A 24-year-old female was found in the driver’s seat within a completely damaged car. Death was pronounced upon arrival to the trauma unit. Figure a (CT slice at the level of the lower chest, lung window) shows a high position of the stomach as evidenced by demonstration of the stomach, the right lung and the visible parts of the left lung at the same level. A small pneumothorax is noted in the anterior part of the left hemithorax (figure a, thin arrow). Patchy infiltrates at the right lung base may represent aspiration or blood (figure a, straight block arrow). The patient most probably had traumatic rupture of the left hemidiaphragm. Mediastinal windows of the same CT slice show a small heart with low density within the right ventricle as compared to the left ventricle (figure b star). This represents diluted blood in the left ventricle. Air is noted in the right ventricle (figure b, straight arrow). The heart is small due to massive blood loss. Demonstration of air within blood vessels and the heart represent postmortem changes and is frequently noted on PMCT within few hours following death. Post Mortem CT Scan: An Alternative Method In Forensic Medicine And Trauma Research