Utility of unenhanced postmortem computed tomography for investigation of in-hospital nontraumatic death in children up to 3 years of age at a single Japanese tertiary care hospital

Abstract

To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ± 8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.

Figure 1

Representative case involving a deceased boy aged 1 year and 3 months. Computed tomography (CT) was performed 16 h and 54 min after death. (A) Ventricular septal defect (arrow) and left ventricular hypoplasia (arrowheads) are suspected on postmortem CT (PMCT). (B) Bilateral lung aeration is not seen on PMCT. Therefore, the main organ–disease system associated with the immediate cause of death was suspected to be the respiratory system. (C) Ventricular septal defect (arrow) and left ventricular hypoplasia (arrowheads) are confirmed by sequential autopsy. Compensatory hypertrophy and dilated hypertrophy of the right ventricle are also seen. Respiratory failure caused by pneumonia and pulmonary edema was confirmed as the immediate cause of death. (D) Histopathological analysis (hematoxylin and eosin staining) shows inflammatory cell infiltration and lung congestion.

Figure 2

Representative case involving a deceased boy aged 1 day. Computed tomography (CT) was performed 17 h and 25 min after death. (A) Postmortem CT (PMCT) shows that the left thoracic cavity contains multiple organs such as the lateral segment of the left hepatic lobe (arrow), spleen (arrowhead), and a part of the intestine. The heart (dotted arrow) and thoracic aorta (curved arrow) are shifted to the right. (B) A coronal multiplanar reconstruction image proves useful for determining the orientation of the organs (arrow, lateral segment of the left hepatic lobe; dotted arrow, heart). Left congenital diaphragmatic hernia was suspected as a major pathological abnormality. Respiratory failure was considered the immediate cause of death. (C) Autopsy reveals left congenital diaphragmatic hernia and herniated structures, including the lateral segment of the left hepatic lobe (arrow) and heart (dotted arrow). Respiratory failure was confirmed as the immediate cause of death.

Figure 3

A representative case involving a deceased boy aged 1 month. Computed tomography (CT) was performed 12 h and 11 min after death. (A) A single ventricle and single atrium are suspected on postmortem CT (PMCT). Intracardiac gas due to the resuscitation attempt is also found. (B) Bilateral pulmonary consolidation is observed on PMCT, and the lungs were suspected to be the main organs associated with the immediate cause of death. However, autopsy localized the heart as the main organ associated with the immediate cause of death, which was confirmed to be circulatory failure.