Conventional Necropsy Research Articles

Fatal upper aerodigestive tract obstruction in an East Asian finless porpoise (Neophocaena asiaeorientalis sunameri): findings in post-mortem computed tomography.

The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem computed tomography (PMCT) visualization techniques and discusses the potential cause of death of this individual. A dead-stranded adult male East Asian finless porpoise was recovered from the Northern coast of Jeju Island, Republic of Korea. The carcass was frozen in Jeju National University within 2h upon first reported. The PMCT examinations were performed at 120 kVp, 200 mAs with a section thickness of 1mm. The scan field of view (sFOV) was set to 400mm. Four image rendering techniques, including multi-planar reconstruction, three-dimensional volume rendering, perspective volume rendering, and minimum intensity projection technique, were used to aid the diagnosis of upper aerodigestive tract obstruction in the stranded finless porpoise. Conventional necropsy was performed to provide a complete necropsy report. Using PMCT, a Sebastidae of 24cm measured length was found to be lodged in the left pharyngeal food channel and esophagus of the finless porpoise. Hard rays of the pectoral fin of the lodged fish have impaled the esophageal mucosa. Fishing gear was found to embed at the dorsal side of the lodged fish. The trachea was compressed ventrally and the arytenoepiglottic tube opening has been narrowed, which may precipitate to the finless porpoise difficult breathing. Pulmonary hyperinflation, pulmonary edema, pneumothorax, pneumopericardium, and pneumorrhachis were observed. This case report represents the first documentation of potential radiological indicators of upper aerodigestive tract obstruction in the East Asian finless porpoise using PMCT. Spatial location of the lodged item could be rendered in situ as the time of death. It has demonstrated that PMCT could provide objective measurements to adjunct the necropsy findings in diagnosis of fatal aerodigestive tract obstruction in stranded cetaceans.

Postmortem Diagnostic Imaging to Evaluate Idiopathic Hypertrophic Cardiomyopathy in a Roborovski Hamster

Idiopathic cardiomyopathy in hamsters can cause death due to cardiac failure. The current case study investigated the capability of imaging to reveal possible cardiomyopathy in a dead hamster. To this end, the cadaver of a 6-month-old male Roborovski dwarf hamster, which showed acute respiratory symptoms a few days before its death, was examined by virtopsy to discover the cause of death. Postmortem radiography was not efficient enough to evaluate the heart due to postmortem lung atelectasis that increases lung opacity and diminishes the contrast between lung and heart. Postmortem computed tomography can be helpful for the assessment of cardiac size. Consistent with postmortem echocardiographic studies, an increased thickness of the left ventricular parietal wall and the interventricular septum and dilation of the left atrium were observed. Thus, hypertrophic cardiomyopathy was determined by imaging and confirmed by the conventional necropsy approach. It showed that the cause of death was acute cardiac failure following idiopathic hypertrophic cardiomyopathy.

An Indo-Pacific humpback dolphin (Sousa chinensis) severely injured by vessel collision: live rescue at sea, clinical care, and postmortem examination using a virtopsy-integrated approach

BackgroundVessel collision induces blunt and sharp force traumas to aquatic animals and is a leading anthropogenic impact affecting cetaceans worldwide. Vessel collision is an important threat affecting vulnerable coastal cetaceans such as the Indo-Pacific humpback dolphins (Sousa chinensis) which reside in coastal waters of Hong Kong amongst heavy marine traffic.Case presentationA severely injured subadult S. chinensis was sighted in the waters off southwestern Hong Kong with four gaping incision wounds on its dorsum. It was in poor body condition and seemed unable to use the fluke effectively. The deepest wound located at the caudal peduncle near the base of the fluke and exposed the underlying fractured caudal vertebrae. The dolphin was monitored in the field over three weeks and eventually captured for medical intervention as veterinary assessment indicated progressive and life-threatening deterioration. During rehabilitation, the dolphin demonstrated initial signs of improvement over the first 36 hours as supported by diagnostic tests but then deteriorated rapidly. It was humanely euthanised after three days of rehabilitation. Postmortem investigation was carried out using virtopsy (postmortem computed tomography and magnetic resonance imaging) and conventional necropsy, with special attention to the traumatic musculoskeletal injuries caused by vessel collision and also revealed acute gastrointestinal compromise and respiratory disease that further hampered the rehabilitation.ConclusionIn cetaceans, the prognosis for recovery from injuries caused by vessel collision depends on the extent, location, and gravity of the injuries (i.e., superficial, deep, penetrating, blunt vs. sharp, fresh vs. septic), as well as the health status of the individual and its ability to respond to the insult. Injuries extending deep into the vertebral column may lead to delayed death and associated welfare issues. The prognosis of this case was likely poor given the severity and location of the injuries, but the attempted rehabilitation and postmortem investigation provided valuable insights for clinical management if similar cases are encountered in the future. Being able to non-invasively assess and document traumatic injuries and other pathologies, diagnostic imaging is particularly useful in the clinical assessment and postmortem investigation (virtopsy) of cases with vessel-induced injuries.

VetVirtopsy by CT and MRI–Complementing conventional necropsy

• Imaging detects the cause of death in a majority of deceased dogs and cats. • Conventional necropsies are not competed; however, they can be simplified and supplemented. • In cases of space-occupying lesions and trauma, imaging finds the causes of death most reliably. • In cases with systemic inflammatory disease, it is most difficult for imaging to arrive at a correct diagnosis. Post mortem (PM) examination of euthanized or deceased individual animals or a herd is important to clarify forensic cases, confirm or correct clinical diagnosis, and improve future therapeutic approaches. The aim of this descriptive study is to evaluate PM imaging by CT and MRI (VetVirtopsy) and to compare the results to conventional necropsy. Hundred deceased or euthanized dogs and cats (47 dogs, 53 cats) of different age, breed, and body weight from the Small Animal Clinic of the University of Zurich underwent VetVirtopsy followed by a conventional necropsy and histologic examination with investigators unblinded to VetVirtopsy. All animals were examined by PM whole body CT (PMCT), 31 of them also by MRI (PMMRI) in selected regions. The findings of VetVirtopsy were compared with the pathology report as the gold standard. In a majority of cases of 81% VetVirtopsy detected the cause of death. The agreement was high in cases with trauma and space occupying lesions and low in systemic inflammatory diseases. VetVirtopsy produced 336 (Median: 3, Min: 1, Max: 11) additional findings in multiple organs. The strengths of VetVirtopsy in supporting conventional necropsy lie in the detection of trauma and space-occupying lesions. Advantageous is the detailed overview, whereby the relevance of the findings must remain in focus. VetVirtopsy could be very helpful in cases without owner consent for dissection. In systemic inflammatory events, disease with discrete, morphologic changes, or in contagious, at most zoonotic cases, it would need imaging-guided specimen sampling.

Post-Mortem Computed Tomography Pulmonary Findings in Harbor Porpoises (Phocoena phocoena).

Simple SummaryThe use of cross-sectional imaging techniques to examine the cause of death and health status of deceased animals is increasing in both veterinary and wildlife conservation programs, including species of whales and dolphins. Lung disease is common in harbor porpoises (Phocoena phocoena), a small whale species that regularly washes up on the coast in North Sea-bordering countries. This study aimed to describe lung changes visible in computed tomographic (CT) images of recently deceased harbor porpoises before pathological dissection was performed, including comparison of these two examination methods. Despite frequently visible signs of body decomposition, several lung abnormalities (collapsed lung, fluid in the airways, lung mineralization) were more often seen on the CT images. In general, lung changes could be described in more detail compared to gross dissection. CT images of lungs of recently deceased harbor porpoises can therefore be used to guide gross dissection, leading to more specific findings and potentially a more complete understanding of the circumstances leading to the death of the porpoise, assessment of the population, and ultimately, ecosystem health.The application of whole-body post-mortem computed tomography (PMCT) in veterinary and wildlife post-mortem research programs is advancing. A high incidence of pulmonary pathology is reported in the harbor porpoise (Phocoena phocoena). In this study, the value of PMCT focused on pulmonary assessment is evaluated. The objectives of this study were to describe pulmonary changes as well as autolytic features detected by PMCT examination and to compare those findings with conventional necropsy. Retrospective evaluation of whole-body PMCT images of 46 relatively fresh harbor porpoises and corresponding conventional necropsy reports was carried out, with a special focus on the respiratory tract. Common pulmonary PMCT findings included: moderate (24/46) to severe (19/46) increased pulmonary soft tissue attenuation, severe parasite burden (17/46), bronchial wall thickening (30/46), and mild autolysis (26/46). Compared to conventional necropsy, PMCT more frequently identified pneumothorax (5/46 vs. none), tracheal content (26/46 vs. 7/46), and macroscopic pulmonary mineralization (23/46 vs. 11/46), and provided more information of the distribution of pulmonary changes. These results indicate that PMCT adds information on pulmonary assessment and is a promising complementary technique for necropsy, despite the frequent presence of mild autolytic features.

Characterisation of Crassicauda fuelleborni nematode infection in Indo-Pacific finless porpoises (Neophocaena phocaenoides) using postmortem computed tomography.

Nematodes of the genus Crassicauda are parasites that infect various body tissues of cetaceans, including the mammary glands which can influence the reproductive output and hence threaten the survival of endangered cetacean populations. In this study, postmortem computed tomography (PMCT) was used to characterise lesions related to Crassicauda fuelleborni infections in stranded Indo-Pacific finless porpoises (Neophocaena phocaenoides) from Hong Kong waters. Using PMCT and subsequently verified by conventional necropsy, Crassicauda-related lesions were found in 52% of finless porpoises examined (n = 13/25), including both males and females. These parasitic lesions were mostly located in the ventral abdominal muscles in both sexes and situated in proximity to the mammary glands in females. C. fuelleborni infections were also found in the male reproductive organs, which to our knowledge have not been reported in this cetacean species previously. PMCT characteristics of the lesions were also correlated with the gross appearance observed at necropsy and the chronicity of the parasitic infections. In conclusion, this study established the use of virtopsy, particularly PMCT, to characterise C. fuelleborni infections in stranded finless porpoises for the first time, which is non-invasive and can be used prior to conventional necropsy to aid disease diagnosis and targeted sampling. This technique can be extended to other species of cetaceans and parasites, as well as being used in the retrospective analysis of past PMCT scans to deepen our understanding of the prevalence, health impacts, and ecological implications of parasitic infection in cetaceans.

Virtopsy as a Revolutionary Tool for Cetacean Stranding Programs: Implementation and Management

On top of conventional necropsy, virtopsy (postmortem computed tomography and postmortem magnetic resonance imaging) has been integrated into the Cetacean Stranding Response Programme in Hong Kong since March 2014. To date, 177 out of 240 local stranded cetaceans have been examined by virtopsy. This integration has modernised the characterisation and documentation of cetacean biological health profiles and causes of death. During this 6-year period, critical pitfalls regarding logistics, carcass recovery, handling, and preservation have been identified. A strategic management scheme is crucial for the successful incorporation of virtopsy into this pioneer programme. This study explains the workflow of the Cetacean Virtopsy Stranding Response Programme in Hong Kong waters. Difficulties encountered are highlighted and practical solutions to address management issues are proposed to consolidate the stranding response network.

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

In the course of the pioneering virtopsy-driven cetacean stranding response program in the Hong Kong waters, postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging (PMMRI) have been implemented to provide supplementary or complementary information for conventional necropsy. Stranded carcasses are often 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 been focused on neuroanatomy and brain morphology in freshly deceased or preserved specimens. The literature is devoid of any reference on the potential value of PMMRI examination of decomposed cetacean brains. 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. The results of the present study indicated that superiority of PMMRI compared to PMCT increased with advancing putrefaction in brain. The preservation of structural integrity was visualized by PMMRI due to its superior ability to depict soft tissue. PMMRI brain should be incorporated in postmortem investigation of decomposed stranded cetaceans.

Nankeen ink model for histological distribution of solutions used in post mortem CT-angiography

• It was possible to identify impregnation in capilar lumen on histological slices. • Nankeen ink allow histological distribution evaluation of the contrast used in PMCTA. • PEG and contrast mixtures reached the minor vessels of all the evaluated organs. • Soybean oil and contrast mixtures reached the minor vessels of all the evaluated organs. • No artifacts or histological damages were seen after the mixture injection. Post mortem computed tomography angiography (PMCTA) is an imaging modality that uses several different contrast solutions in order to highlight blood vessel paths in cadavers. This technique shows similar results when compared to conventional necropsy, especially for traumatic or vascular diseases. However, it is still unknown whether the chemical and histological features remain preserved after the intravascular injection of contrast solution for PMCTA. The aim of this study was to establish the histological regions reached by the contrast medium solution after a PMCTA procedure and to verify if the tissue architecture was preserved, using two different types of fluids to compose the solution (watery and oil fluid). A nankeen ink model was used in 2 dog cadavers with 2 different contrast solution, and a histological evaluation of the lung, liver and kidney was carried out. Nankeen ink impregnation was observed in all samples collected after the mixture injection showing the presence of ink impregnation within the blood vessel lumens. No histological artifacts were found and, moreover, histological architecture damages were not observed in those samples collected. It had been demonstrated that this nankeen ink model can be used for further studies in due to better understand the histological distribution of the contrast solution used in PMCTA procedures.

Genetic sampling identifies canid predators of koalas (Phascolarctos cinereus) in peri-urban areas

An understanding of the threats to threatened species in urban and peri-urban areas is essential to develop successful management approaches. Dog attacks are considered to be a major contributor to koala (Phascolarctos cinereus) mortalities in peri-urban areas of north-eastern Australia. Predation could be due to either domestic dogs or wild dogs (dingoes and dingo-domestic dog hybrids), gentically-identifiable groups of Canis familiaris. Here, we aimed to use genetic sampling methods to determine or verify the identity, number and successful removal of canid predators of koalas in a peri-urban environment in south-eastern Queensland. Genetic samples were taken from the remains of 12 koalas suspected to have died from predation. Canine genotypes were present on 11 of 12 predated koalas (∼92%) and were from wild dogs, not domestic dogs. Most koalas had only one canine genotype identified, suggesting they were killed by a single dog. Our results show that DNA samples collected from deceased prey species can be used to identify the predator, and distinguish between closely-related species, and hybrids of the two. Genetic methods confirmed the identification of the predator obtained through conventional necropsy and support growing evidence that wild dog predation is a significant cause of koala mortality in this region. Strategies to reduce predation on koalas should therefore focus on reducing the impact of free-ranging wild dog populations. This approach is important to identify and target those canids responsible for predation of threatened prey populations, particularly where multiple predators are present and/or predator removals may be controversial.

Post Mortem Ultrasound and Computed Tomography Findings of an Extraluminal Urinary Bladder Leiomyoma in a Dog

Background: Neoplasia of the urinary bladder is common in dogs, accounting approximately 0.5 to 1.0 percent of all neoplasms. Most of the neoplasia of the urinary bladder is epithelial in origin and only 10% of urinary bladder neoplasms in dogs are from mesenchymal origin, of which the most frequent types are leiomyoma / leiomyosarcoma, and hemangioma / hemangiosarcoma. Virtual autopsy refers to the postmortem use of radiology, ultrasound and cross-sectional imaging prior to conventional necropsy. This paper reports the detection of a rare extra-luminal urinary bladder mass diagnosed as leiomyoma with a virtual autopsy techniques.Case: A 16-year-old male Schnauzer had previous history of seizure and no complains related to the urinary system. The animal was treated symptomatically to the neurological signs and responded to medical treatment. Nine weeks later from the first visit to the hospital the dog was found dead at home. Then postmortem ultrasound and computed tomography of the abdomen were performed. Postmortem ultrasound revealed a homogenously hypoechoic, rounded and slightly irregularly marginated mass located externally but adjacent to the left cranial wall of the urinary bladder and appears to extend from its serosal margins. Postmortem computed tomography was performed after postmortem ultrasound. A pedunculated homogenous soft tissue attenuating mass was located at the left lateral aspect of the urinary bladder and extended cranially. It had a stalk that connected to the left lateral wall of the urinary bladder. A partial necropsy of the abdomen was done just to examine the mass. A round extraluminal, pedunculated mass was observed at the left lateral aspect of the urinary bladder wall. It was pale pink on the outside and white inside, with a soft to firm consistency. The lumen and mucosal surface of the urinary bladder was smooth and regular. The histology of the mass revealed a densely cellular neoplastic proliferation, expansive, composed of spindle-shaped cells with moderate to large eosinophilic cytoplasm, sometimes wavy and with indistinct edges. The nuclei were large, oval to flattened, with dense chromatin and inconspicuous nucleoli. Anisocytosis and anisokariosis were discrete and no mitotic figures were observed. The arrangement consisted of dense, irregular and multidirectional bundles and the stroma was scarce. The mass was histologically confirmed as leiomyoma.Discussion: In this case, we performed postmortem ultrasound and computed tomography as part of a virtual necropsy study and in both modalities the urinary bladder mass was able to be identified, followed by a partial necropsy to further investigate the nature of the mass and to collect a sample to obtain the histological diagnosis. A few of the disadvantages of the postmortem ultrasound and computed tomography specially in this case were the lack of color Doppler investigation on ultrasound and the lack of evaluation of the patter of contrast enhancement on computed tomography. These techniques could have added important information related to the vascularity characteristics of the mass in a live patient. This is the first case report in veterinary medicine that describes an extra-luminal pedunculated urinary bladder leiomyoma in a canine patient, and it is emphasized the approach by postmortem ultrasound, postmortem computed tomography and conventional necropsy findings to reach the definitive diagnosis.

Autopsy imaging for cardiac tamponade in a Thoroughbred foal.

ABSTRACTAutopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death.

Fetal heart pathology on postmortem 3‐T magnetic resonance imaging

Postmortem magnetic resonance imaging (pmMRI) is increasingly used in perinatology, typically as an alternative or complement to conventional necropsy for central nervous system anomalies. Overall, it provides reliable information on structural malformations but was shown to be of limited use in examining the fetal heart. We aimed to assess the fetal heart on 3-T pmMRI in a consecutive series of fetuses with structural congenital heart defects (CHD) and to determine diagnostic evaluation limits in case of CHD. A single-center database was retrospectively reviewed. Only fetuses having CHD of functional significance were included. Fetal cardiac anatomy was assessed on T2-weighted 3D multiplanar reconstructed images acquired using isovolumetric voxel size (0.3-0.8 mm(3) ), which allows to visualize cardiac structures in situ in multiple fetal body planes. Cardiac pathology was classified into complex and isolated CHD. On the basis of clinically relevant findings, pmMRI was considered either diagnostic or not diagnostic. A total of 24 fetuses were included in this study. The median gestational age was 22 weeks and 2 days (range 12w5d-34w6d). The median delay between delivery of the fetus and MR was 6 h and 30 min (range 1 h and 30 min-19 h). PmMRI was diagnostic for 12 out of 13 (92.3%) complex CHD and for 6 out of 11 (54.5%) isolated CHD. In case of valvular malformation, a tentative diagnosis was reached in 7/11 cases (64%) on the basis of indirect features. Postmortem MRI is a valid diagnostic tool for CHD in fetuses beyond 16 weeks up to term.

Virtopsy in a Red Kangaroo with Oral Osteomyelitis

This report describes the use of computed tomography (CT) in a nondomestic species. Postmortem CT was performed on a red kangaroo (Macropus rufus) and a diagnosis of oral osteomyelitis was made. CT examination revealed bony remodeling of the right mandible, an intraosseous lesion of the right temporal bone, muscle necrosis around the right mandible, and the absence of the right, first, upper molar tooth. Cardiac and intrahepatic gas and a distended intestine due to postmortem gas accumulation were also seen. All the lesions identified with CT were also identified by conventional necropsy, except the cardiac and intrahepatic gases. Virtopsy may be a useful procedure for the noninvasive identification of cause of death and as a guide for necropsy in animals.

Urinary Tract Lesions in Cats And Dogs: Epidemio-Pathological Study

The present study aimed to provide an epidemiological and pathological study on urinary tract diseases in dogs and cats, spontaneous cases, encountered in the Department of Pathology, Forensic Medicine, and Necropsy Diagnosis of FMV Cluj from 1st January 2008 to 1st March 2010. The biological material was represented by 49 cadavers, respectively 15 cats and 34 dogs which presented lesions of the urinary tract. The animals were brought to the Veterinary Pathology Department for the necropsy and histopathological exam. Necropsy was performed according to conventional necropsy technique. This was followed by collection of biological samples, inserted into the fixative agent (10% formalin, pH 7) for 24 hours then processed through the paraffin inclusion technique and examined microscopically for histopathological diagnosis. Histological analysis of samples was performed with an Olympus BX 41 optical microscope and image processing was performed using the software CellB. From the total of 768 animals (635 dogs and 133 cats) which were examined during the mentioned period, only 49 animals (6.38%) presented urinary tract lesions. A total of 11.27% of the investigated cats and 5.35% of the investigated dogs presented urinary tract disorders (table 1).Urinary tract pathology, respectively mainly renal pathology, is more important in cats than in dogs, and most significant lesions were represented by acute tubular necrosis (following ethylene-glycol intoxication), chronic fibrous and proliferative nephritis and lipid dystrophy. In dogs, the lesions that predominated were represented by acute and chronic renal infarcts, chronic nephritis (of fibrous and lympho-hystiocitic type), acute tubular necrosis and dystrophies (such as mineralization and hyalinization).

OP03.05: Confidence of reporting fetal virtuopsy as compared to conventional necropsy

Objectives: Postmortem fetal MRI combined with computer tomography (‘virtuopsy’) may be a more acceptable alternative for parents declining conventional necropsy. We aimed to compare the acceptance of both examinations and to determine the confidence with which virtuopsy can report on various fetal organs. Methods: In 50 cases of in utero fetal death, virtuopsy and necropsy were offered to parents. In cases where parents consented for both examinations and based on an adapted scale by Breeze (UOG 2006; 28:918–924) confidence in virtuopsy was determined on a scale where conventional necropsy is considered the gold standard. Autopsy was classified as either ‘normal’ (N) or ‘abnormal’ (aN) organs; groups were analyzed separately. At virtuopsy, we used a scale (0 = definitely aN, 50 = unable to comment, 100 = definitely N, 0–50 probably aN and 50–100 probably N) to indicate confidence of each anatomical structure in both groups defined at postmortem autopsy. Results: 98%(49/50) of parents resp. 58%(29/50) consented for virtuopsy resp. necropsy and virtuopsy. Gestational age ranged between 15 and 38 weeks, weight ranged between 52 and 3195 g. For fetuses with N/aN organs at necropsy, virtuopsy showed high confidence scores (> 80) resp. (< 20) for detecting anomalies for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. However, in two cases, virtuopsy diagnosed a brain anomaly where postmortem autopsy was inconclusive. Conclusions: Virtuopsy provided information of comparable diagnostic utility to that obtained by necropsy for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. Virtuopsy was particularly useful for the brain where practical difficulties with handling unfixed tissues arise. Although necropsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined.

OP03.06: Diffusion‐weighted magnetic resonance imaging of the human placenta

Objectives: Postmortem fetal MRI combined with computer tomography (‘virtuopsy’) may be a more acceptable alternative for parents declining conventional necropsy. We aimed to compare the acceptance of both examinations and to determine the confidence with which virtuopsy can report on various fetal organs. Methods: In 50 cases of in utero fetal death, virtuopsy and necropsy were offered to parents. In cases where parents consented for both examinations and based on an adapted scale by Breeze (UOG 2006; 28:918–924) confidence in virtuopsy was determined on a scale where conventional necropsy is considered the gold standard. Autopsy was classified as either ‘normal’ (N) or ‘abnormal’ (aN) organs; groups were analyzed separately. At virtuopsy, we used a scale (0 = definitely aN, 50 = unable to comment, 100 = definitely N, 0–50 probably aN and 50–100 probably N) to indicate confidence of each anatomical structure in both groups defined at postmortem autopsy. Results: 98%(49/50) of parents resp. 58%(29/50) consented for virtuopsy resp. necropsy and virtuopsy. Gestational age ranged between 15 and 38 weeks, weight ranged between 52 and 3195 g. For fetuses with N/aN organs at necropsy, virtuopsy showed high confidence scores (> 80) resp. (< 20) for detecting anomalies for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. However, in two cases, virtuopsy diagnosed a brain anomaly where postmortem autopsy was inconclusive. Conclusions: Virtuopsy provided information of comparable diagnostic utility to that obtained by necropsy for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. Virtuopsy was particularly useful for the brain where practical difficulties with handling unfixed tissues arise. Although necropsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined.

Endoscopic Autopsy

In cases in which the family of the deceased objects to the performance of a conventional autopsy for religious or other reasons, or where there are no forensic pathology facilities in the vicinity of the hospital, postmortem endoscopic examination may be an advantageous and cost-effective substitute for conventional necropsy, especially when the alternative is no postmortem examination at all. To test the reliability of postmortem endoscopy, conventional and endoscopic autopsies were performed on 20 cadavers at the L. Greenberg Institute of Forensic Medicine in Israel. Comparison of the findings of the two procedures showed a very high correlation (100%) for intraperitoneal and thoracic hemorrhages and hepatic, splenic, and diaphragmatic injuries; it showed a slightly lower correlation (60-80%) for mesenteric and retroperitoneal hematomas injuries to the great vessels, blood aspiration, and lung injury. Endoscopy failed to reveal the correct site of injury in the retroperitoneum and posterior aspect of the mediastinum. Collection of body fluids and tissue samples was possible by means of laparoscopy. The technique proved to be relatively accurate, more rapid than conventional autopsy, and left the body virtually intact.