Postmortem ventilation: a new method for improved detection of pulmonary pathologies in forensic imaging

Area of Science:

• Forensic Pathology
• Radiology
• Pulmonary Medicine

Background:

• Postmortem imaging, particularly postmortem computed tomography (pmCT), is crucial in forensic pathology.
• Evaluating postmortem lung pathologies can be challenging due to lung collapse and postmortem changes.
• Standard imaging techniques may not adequately reveal subtle lung abnormalities.

Purpose of the Study:

• To investigate the effect of postmortem ventilation on lung volume and pathology visualization.
• To determine the optimal ventilation pressure for improving postmortem lung evaluation.
• To assess the feasibility of using postmortem ventilation in conjunction with pmCT.

Main Methods:

• Ten human corpses underwent postmortem ventilation using a portable ventilator.
• Ventilation was applied via continuous positive airway pressure mask, endotracheal tube, or laryngeal mask.
• Postmortem computed tomography (pmCT) scans were performed simultaneously with ventilation at pressures of 10, 20, 30, and 40 mbar.
• Lung volumes were measured using segmentation techniques on CT data.
• Changes in lung morphology and pathology visibility were analyzed.

Main Results:

• Postmortem ventilation, especially at 40 mbar, significantly increased lung volume (mean increase of 1.32 L) and promoted lung unfolding.
• This increased lung volume facilitated the detection of small pathologies like scarring, nodules, and emphysema.
• Higher ventilation pressures (40 mbar) were most effective in reducing postmortem artifacts (livores), enhancing pathology visualization.
• Ventilation also led to decreased heart diameter and recognized gaseous stomach distension.

Conclusions:

• Postmortem ventilation is a feasible and effective method for enhancing lung evaluation in forensic investigations.
• Applying 40 mbar of positive airway pressure during pmCT improves the detection of subtle lung pathologies.
• This technique offers a valuable adjunct to traditional postmortem imaging for comprehensive lung assessment.