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Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings

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Abstract

In their daily forensic casework, the authors experienced discrepancies of tracheobronchial content findings between postmortem computed tomography (PMCT) and autopsy to an extent previously unnoticed in the literature. The goal of this study was to evaluate such discrepancies in routine forensic cases. A total of 327 cases that underwent PMCT prior to routine forensic autopsy were retrospectively evaluated for tracheal and bronchial contents according to PMCT and autopsy findings. Hounsfield unit (HU) values of tracheobronchial contents, causes of death, and presence of pulmonary edema were assessed in mismatching and matching cases. Comparing contents in PMCT and autopsy in each of the separately evaluated compartments of the respiratory tract low positive predictive values were assessed (trachea, 38.2 %; main bronchi, 40 %; peripheral bronchi, 69.1 %) indicating high discrepancy rates. The majority of tracheobronchial contents were viscous stomach contents in matching cases and low radiodensity materials (i.e., HU < 30) in mismatching cases. The majority of causes of death were cardiac related in the matching cases and skull/brain trauma in the mismatching cases. In mismatching cases, frequency of pulmonary edema was significantly higher than in matching cases. It can be concluded that discrepancies in tracheobronchial contents observed between PMCT and routine forensic autopsy occur in a considerable number of cases. Discrepancies may be explained by the runoff of contents via nose and mouth during external examination and the flow back of tracheal and main bronchial contents into the lungs caused by upright movement of the respiratory tract at autopsy.

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Abbreviations

CI:

Confidence interval

FN:

False negative

FP:

False positive

HU:

Hounsfield unit

NPV:

Negative predictive value

PMCT:

Postmortem computed tomography

PMI:

Postmortem interval

PPV:

Positive predictive value

ROI:

Region of interest

TN:

True negative

TP:

True positive

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Acknowledgments

We would like to express our gratitude to the team of forensic pathologists and forensic technicians from the Department of Forensic Medicine, Institute of Forensic Medicine, University of Bern, for their support with case handling.

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Authors and Affiliations

  1. Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland

    Wolf-Dieter Zech, Christian Jackowski, Nicole Schwendener, Eva Brencicova, Frederick Schuster & Paolo Lombardo

  2. Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, Bern, CH-3010, Switzerland

    Frederick Schuster

  3. Department of Diagnostic Imaging and Radiotherapy of the University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy

    Paolo Lombardo

Authors
  1. Wolf-Dieter Zech
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  2. Christian Jackowski
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  3. Nicole Schwendener
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  4. Eva Brencicova
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  5. Frederick Schuster
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  6. Paolo Lombardo
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Correspondence to Wolf-Dieter Zech.

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Zech, WD., Jackowski, C., Schwendener, N. et al. Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings. Int J Legal Med 130, 191–198 (2016). https://doi.org/10.1007/s00414-015-1264-5

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  • DOI: https://doi.org/10.1007/s00414-015-1264-5

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