Forensic insights into primary pyomyositis: autopsy and post-mortem CT scan based-analysis.

Area of Science:

• Forensic Pathology
• Radiology
• Infectious Diseases

Background:

• Pyomyositis is a serious intramuscular infection often diagnosed clinically.
• Postmortem diagnosis presents unique challenges, especially in identifying subtle infectious processes.

Purpose of the Study:

• To evaluate the utility of postmortem computed tomography (CT) in diagnosing primary pyomyositis.
• To establish an effective diagnostic approach for pyomyositis in the forensic setting.

Main Methods:

• Retrospective review of 6,964 autopsy cases with CT imaging from two forensic centers.
• Analysis of demographics, external findings, CT imaging features, and autopsy results for primary pyomyositis.

Main Results:

• Ten cases of primary pyomyositis were identified, predominantly in individuals over 40 years old.
• CT imaging revealed characteristic findings (swelling, fat stranding, fluid collection, gas) in nine cases.
• Grossly identifiable erythema was rare (3/10 cases), and pre-autopsy signs of infection were uncommon (1/10 cases).

Conclusions:

• Postmortem CT is a sensitive tool for detecting pyomyositis, complementing limited external findings.
• The demographic profile (older age, no HIV) and delayed presentation (post-trauma) in this series differ from clinical cohorts.
• CT imaging aids in establishing the diagnosis of pyomyositis in the postmortem setting, overcoming diagnostic challenges.