Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children
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Published on: September 27, 2020
Maïa Proisy1, Antoine Jérôme Marchand, Philippe Loget
1Department of Radiology, Rennes University Hospital, CHU Hôpital Sud, Boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France. maia-proisy@orange.fr
Insights
Whole-body post-mortem computed tomography (PMCT) is a valuable non-invasive tool for investigating sudden unexpected deaths in children. It aids in identifying causes of death and detecting non-accidental injuries, showing good concordance with autopsy findings.
Area of Science:
- Forensic Pathology
- Medical Imaging
- Pediatric Pathology
Background:
- Sudden unexpected death in infants and children (SUDIC) presents diagnostic challenges.
- Traditional autopsy methods may be invasive and sometimes inconclusive.
- Post-mortem imaging offers a non-invasive complementary approach.
Purpose of the Study:
- To evaluate the utility of whole-body post-mortem computed tomography (PMCT) in SUDIC cases.
- To assess the concordance of PMCT findings with autopsy results.
- To determine PMCT's role in detecting specific causes of death, including child abuse.
Main Methods:
- Retrospective analysis of 47 SUDIC cases.
- Inclusion of radiographic skeletal surveys, whole-body PMCT, and autopsy.
- Correlation of imaging findings with autopsy results, distinguishing post-mortem changes from pathological findings.
Main Results:
- Autopsy determined the cause of death in 38.3% of cases (child abuse, infections, metabolic disease, volvulus).
- PMCT results largely agreed with autopsy findings, with discrepancies noted in pulmonary cases.
- In 61.7% of cases, the cause of death remained unexplained, with no significant abnormal PMCT findings.
Conclusions:
- Whole-body PMCT is an effective non-invasive method for investigating SUDIC.
- PMCT is crucial for identifying non-accidental injuries (child abuse).
- PMCT demonstrates significant concordance with autopsy and can guide dissection, especially when autopsy is declined.
Objectives:
To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children.
Methods:
Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings.
Results:
There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis.
Conclusions:
Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives.
Key Points:
• Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method. • Whole-body PMCT is essential for detecting child abuse in unexpected death. • There is concordance on cause of death between PMCT and autopsy. • Whole-body PMCT could improve autopsy through dissection and sampling guidance. • PMCT shows findings that may be relevant when parents reject autopsy.
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