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Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children

  • Pediatric
  • Published:
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Abstract

Objectives

To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children.

Methods

Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings.

Results

There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis.

Conclusions

Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives.

Key Points

• Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method.

• Whole-body PMCT is essential for detecting child abuse in unexpected death.

• There is concordance on cause of death between PMCT and autopsy.

• Whole-body PMCT could improve autopsy through dissection and sampling guidance.

• PMCT shows findings that may be relevant when parents reject autopsy.

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Abbreviations

CNS:

central nervous system

CPA:

cardiopulmonary arrest

CPR:

cardiopulmonary resuscitation

GGO:

ground glass opacity

IVG:

intravascular gas

NAI:

non-accidental injury

PMCT:

post-mortem computed tomography

SAH:

subarachnoid haemorrhage

SDH:

subdural haemorrhage

SUDI:

sudden unexpected death in infancy

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Acknowledgments

The authors thank Prof. Yves Gandon for checking the manuscript and Mrs Tracey Westcott for editorial assistance.

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Authors and Affiliations

  1. Department of Radiology, Rennes University Hospital, CHU Hôpital Sud, Boulevard de Bulgarie, BP 90347, 35203, Rennes Cedex 2, France

    Maïa Proisy, Antoine Jérôme Marchand, Céline Rozel, Catherine Treguier, Pierre Darnault & Bertrand Bruneau

  2. Department of Pathology, University Hospital, Rennes, France

    Philippe Loget

  3. Department of Legal Medicine, University Hospital, Rennes, France

    Renaud Bouvet

  4. Department of Paediatrics, University Hospital, Rennes, France

    Michel Roussey

  5. Epidemiological and Public Health Service, University Hospital, Rennes, France

    Fabienne Pelé

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  1. Maïa Proisy
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  2. Antoine Jérôme Marchand
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  3. Philippe Loget
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Correspondence to Maïa Proisy.

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Proisy, M., Marchand, A.J., Loget, P. et al. Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. Eur Radiol 23, 1711–1719 (2013). https://doi.org/10.1007/s00330-012-2738-1

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  • DOI: https://doi.org/10.1007/s00330-012-2738-1

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