Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Area of Science:

• Forensic Pathology
• Radiology
• Medical Law

Background:

• Postmortem computed tomography (PMCT) is increasingly used for death certification, especially in low-autopsy countries like Japan.
• Clinical personnel, often untrained in PMCT interpretation, are frequently tasked with this role as police doctors.
• Potential pitfalls exist in PMCT interpretation and its integration into forensic investigations.

Observation:

• Five cases illustrate misdiagnosis of cause of death (COD) due to PMCT misinterpretation.
• Errors included misinterpreting postmortem changes, resuscitation effects, incomplete examinations, and confusing internal vs. external findings.
• Non-fatal findings were sometimes wrongly identified as fatal.

Findings:

• PMCT misinterpretation by untrained physicians can lead to incorrect COD certification.
• Incomplete forensic investigations exacerbate the risk of diagnostic errors.
• Autopsy revealed significant discrepancies between initial PMCT interpretations and actual COD.

Implications:

• Accurate COD determination requires appropriately trained physicians interpreting PMCT.
• A comprehensive forensic investigation, including autopsy when necessary, is vital.
• Preventing medicolegal consequences hinges on rigorous PMCT interpretation and investigation standards.