Temporal evolution in peritoneal hemorrhage as depicted by postmortem CT

Computed Tomography (CT) is now utilized as an effective tool for postmortem diagnoses. However, reports on the temporal evolution in imaging findings of these postmortem CT is limited.

One night, a 66 year old male following drinking at a bar on his way home slept in the road. He was ran over by a taxi at 01:28 and immediately transferred to a nearby hospital. During his transfer to the hospital, he lost consciousness and fell into a state of cardiopulmonary arrest, and died despite resuscitation attempts. CT images were taken at 02:30. Following this, CT images were re-taken 54 h after death, just prior to a medicolegal autopsy.

Small amount of intra-abdominal hemorrhage was found during the initial CT examination. However, the extent of intra-abdominal bleeding observed during the second CT examination performed 54 h later had substantially increased. During the autopsy, the amount of intra-abdominal hemorrhage was 1700 mL. Injury to the mesentery, liver and pancreas was also observed. Additional major injuries discovered during the autopsy were, skin abrasions and lacerations of the scalp, subarachnoid hemorrhage, fractures of the ribs, right humerus, and pelvic bones. The deceased postmortem blood alcohol level was 2.4 mg/mL. The cause of death was determined as exanguination due to systemic injury. The mechanism of the postmortem increase in the intra-abdominal hemorrhage remained unknown. However, the amount of bleeding found during autopsies may not be the same as that at the time of death. As a result, the criteria for the diagnosis of the cause of death in autopsies should be carefully reconsidered. In addition, accompanying CT imaging at the time of death and possible postmortem changes should be carefully considered in postmortem CT imaging, so that there will not be incorrect assignment of the causes of death.