Paediatric and perinatal postmortem imaging: the need for a subspecialty approach

Abstract

Paediatric postmortem imaging is distinct and different from adult postmortem imaging due to differences in disease aetiology, pathology and imaging approaches, which require a particular skill set to maximise its yield and clinical utility. Practitioners need to have expertise in several aspects of radiology, including both plain radiographs and cross-sectional imaging modalities, knowledge of specialist techniques, and familiarity with the unique range of pathologies in this patient population, including perinatal pathology. Here we outline the training requirements that should be considered to establish such a service.

Fig. 1

Perinatal mortality rates by European country. Adapted with permission from de Jonge et al., 2013 [2]

Fig. 2

Postmortem CT of a male foetus who died at 22 weeks after a terminated pregnancy following antenatal sonographic diagnosis of holoprosencephaly and a midline facial defect. a Surface-rendered postmortem CT shows a cleft lip (black arrow), the presence of an interorbital proboscis (white arrow) and two eyes. b Three-dimensional reconstruction of the skull shows a midline defect with absence of bony medial boundaries of the orbits. Postmortem moulding has caused diastasis of the parietal and occipital bones (white arrows). Based on the imaging findings, a diagnosis of ethmocephaly was made; parental consent for autopsy was refused

Fig. 3

Postmortem axial MRI of the chest of an 8-month-old boy who died of unknown causes. Unusually, there was apparent sedimentation/layering of blood in the pericardial sac (a) as well as in the left pleural cavity (b), which was attributed to traumatic pericardiocentesis during resuscitation. There was no evidence of trauma

Fig. 4

Postmortem skeletal radiograph (a) and 3-D postmortem CT reconstruction (b) of a 20-week male foetus. The pregnancy was terminated for suspected skeletal dysplasia. There is severe under-mineralisation of the entire skeleton, beading of the ribs and bowing and crumpling of the long bones, caused by multiple fractures. These appearances are typical for lethal congenital osteogenesis imperfecta (type II), which was confirmed on genetic testing