Current techniques in postmortem imaging with specific attention to paediatric applications

Abstract

In this review we discuss the decline of and current controversies regarding conventional autopsies and the use of postmortem radiology as an adjunct to and a possible alternative for the conventional autopsy. We will address the radiological techniques and applications for postmortem imaging in children.

Fig. 1

A neonate aborted at 14 weeks gestational age. a Antenatal US showed severe dysmorphological changes. Photograph of the foetus shows the fused lower extremity. The insert depicts the size of the foetus in relation to the fingertip of the pathology assistant (arrow). b Radiography, performed on a mammography system, shows a sirenomelia. The skeleton is exquisitely depicted

Fig. 2

A 3 ½-month-old girl died under suspicious circumstances. Judicial autopsy was warranted. Contact radiograph (performed on mammography system) shows a fracture of the second rib on the left with consolidation (arrow) but also a fresh fracture (arrowhead). The latter was, even in retrospect, not visible on CR or CT (not shown here) (Reprinted with permission from Bilo RA, Robben SG, van Rijn RR [2009] Forensic aspects of paediatric fractures: differentiating accidental trauma from child abuse. Springer-Verlag, in press)

Fig. 3

Postmortem US shows portal air (arrow), a common finding in postmortem imaging

Fig. 4

A neonate, born at 41 weeks gestational age, who died shortly after birth. a Antenatal US showed an underdeveloped thorax and short stature (T2-W 3-D, slice thickness: 1 mm, TR: 4000, TE: 80). b Chest radiograph shows a severely constricted thoracic cage, underdeveloped scapulae and flattened vertebrae. c Radiograph of the pelvis shows hypoplastic iliac wings and sciatic notch spurs (arrow). Based on the conventional radiological findings, the diagnosis thanatophoric dysplasia type II is most likely (OMIM #187601)

Fig. 5

A neonate aborted at 31 weeks gestational age. Antenatal US showed abnormal brain development. Autopsy was refused by the parents. T1-W MRI shows asymmetrical development of the brain with overgrowth of the right side, in keeping with hemimegalencephaly. On the right side multiple focal hemorrhagic lesions are seen (arrow) (slice thickness: 1 mm, TR: 9, TE: 4,1) [58]

Fig. 6

A neonate with a congenital cyanotic heart disease born at 39 weeks. Maximum support and 100% oxygen did not lead to clinical improvement and the child died. T2-W coronal MRI shows a complete anomalous venous return (arrow) with pulmonary interstitial oedema (insert). A central tendon defect is seen (open arrow) (slice thickness: 2 mm, TR: 5500, TE: 54, FA: 180°). b T2-W coronal MRI shows a persistent left superior caval vein (arrow), a dextrocardia and situs intermedius of the liver. Asplenia was also noted

Fig. 7

A 6-month-old boy who died after attempted resuscitation. On postmortem, CT air is seen in all major vessels. On autopsy a positive blood culture for S. aureus was found. The cause of death was a fulminant sepsis

Fig. 8

A 2-month-old neonate presented at the emergency department in severe cardiac and respiratory distress. Resuscitation was unsuccessful. Coronal T2-W MRI shows hematopericard (open arrow), hematothorax (arrow) and a pleural effusion (arrowhead) (slice thickness: 1 mm, TR: 4000, TE: 80, FA: 90°). There is an abberant pulmonary vein draining into the left ventricle (open arrowhead). The abdomen shows ascites (asterisk)

Fig. 9

A neonate aborted at 20 weeks gestational age. a Antenatal US showed a massively dilated bladder and bilateral hydronephrosis. Sagittal T2-W MRI shows a distended bladder (asterisk) and a dilated posterior urethra (open arrow), consistent with posterior urethral valves (slice thickness: 1 mm, TR: 1500, TE: 161, FA: 150°). Note the fluid-fluid level in the heart (arrow) as a result of blood b Coronal T2-W MRI shows a distended bladder (asterisk) and dilated tortuous ureters (open arrow). There is a substantial bilateral pyelocaliceal dilatation (arrow). There is a relative hypoplasia of the lungs as a result of the oligohydramnion

Fig. 10

A 10-year-old boy who died in the hospital after a fall. a Postmortem CT shows a small pneumothorax, which was not found at autopsy. There is diffuse airway consolidation in keeping with postmortem pulmonary oedema. b Surface-shaded rendering of the thorax shows an incorrectly positioned left subclavian line with the tip of the line in the jugular vein (arrow). The line was cut and the distal end (arrowhead) was buried subcutaneously

Fig. 11

A neonate of unknown gestational age found in a garbage bin. a Coronal T2-W image shows oedema around the right jugular vein (arrow) (slice thickness: 4 mm, TR: 5970, TE: 84, FA: 150°) (Reprinted with permission from Bilo RA, Robben SG, van Rijn RR [2009] Differentiating accidental trauma from child abuse. In: Forensic aspects of pediatric fractures. Springer-Verlag, in press). b Autopsy shows a bilateral haematoma (open arrow) around the jugular vein, the carotid artery and the sternocleidoid muscles (arrow). This finding is fitting with strangulation

Fig. 12

Historical paediatric specimen. a Image of cephalothoracopagus from the Vrolik Museum. Specimen is estimated to be 100–150 years old. b Surface-shaded rendering shows a conjoined skull and chest; the spine, pelvis and extremities are separate. c Coronal T2-W MRI shows individual development of the brain with a clear separation between the right and left side of the craniothoracophagus (open arrow) (slice Thickness: 3 mm, TR: 2500, TE: 68, FA: 90°). The trachea is fused (arrow) and a single diaphragm is present (arrowhead). There is a compound liver (neoaxial orientation), which on further imaging shows two separate gallbladders. Normal renal development is present

Fig. 13

Second historical specimen. a Mummy of a boy, estimated age 9.5–14.5 years, dated to the 3rd century A.D. b Shaded-surface rendering of the face shows facial features. The nose is slightly depressed, likely as a result of mummification. The ear is relatively large and stands off the skull. c Virtual endoscopy of the abdominal cavity shows absence of both abdominal and thoracic organs. The thorax is partially filled with gauzes (asterisk) (courtesy of the National Museum of Antiquities, Leiden, the Netherlands, reprinted with permission from Raven MJ, Taconis WK (eds) [2005] Egyptian mummies: radiological atlas of the collections in the national museum of antiquities in Leiden. Brepols, Turnhout, Belgium, pp 191–195)