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Published on: July 21, 2023
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Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum
Vasiliki Chatzaraki1,2, Michael J Thali3, Garyfalia Ampanozi3
1Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland. chatzaraki@outlook.com.gr.
International Journal of Legal Medicine
|January 7, 2021
Summary
Postmortem computed tomography (PMCT) offers moderate sensitivity and high specificity in identifying bleeding sources in hemoperitoneum cases. Specific radiological signs on PMCT correlate with the cause of bleeding and survival intervals.
Area of Science:
- Forensic Radiology
- Medical Imaging
- Pathology
Background:
- Hemoperitoneum, confirmed at autopsy, presents diagnostic challenges in determining the bleeding source.
- Postmortem computed tomography (PMCT) is increasingly utilized in forensic investigations.
Purpose of the Study:
- To evaluate the accuracy of PMCT and specific radiological signs in identifying bleeding sources in hemoperitoneum cases.
- To correlate radiological findings with the cause and survival intervals of hemoperitoneum.
Main Methods:
- Retrospective review of PMCT data from 85 autopsy-confirmed hemoperitoneum cases.
- Two blinded raters assessed radiological signs: sentinel clot, surrounding blood/sediment, abnormal gas, parenchymal disruption.
- Correlation with autopsy findings regarding bleeding source, cause (traumatic, surgical, natural, resuscitation), and survival intervals.
Main Results:
- PMCT demonstrated 79% sensitivity and 92.1% specificity for detecting bleeding sources.
- The sentinel clot sign was linked to surgical/natural causes and longer survival.
- Sedimented blood indicated resuscitation; abnormal gas and combined signs improved sensitivity.
Conclusions:
- PMCT is a valuable tool for determining bleeding sources in hemoperitoneum, offering high specificity.
- Distinct PMCT signs are associated with specific causes of hemoperitoneum and varying survival durations.
