Usefulness of computed tomography-guided postmortem biopsy to evaluate pneumonia

This study examined the feasibility of utilizing computed tomography (CT)-guided postmortem lung biopsy to diagnose pneumonia and compared the findings from postmortem CT (PMCT) and blood analyses with histopathological results.

The study included 13 patients who had died within 3 days and had confirmed neutrophil infiltration through histopathological examination. All patients underwent PMCT before autopsy, followed by CT-guided postmortem biopsy on the areas with suspected pneumonia. Blood samples were collected from the heart at the start of autopsy, and C-reactive protein (CRP) and presepsin (P-SEP) levels were measured.

PMCT revealed pulmonary hypostasis in five cases (38.5 %). Abnormal appearances were observed bilaterally in six cases (46.2 %) and unilaterally in seven cases (53.8 %). The distribution was diffuse in seven cases (53.8 %) and localized in six cases (46.2 %). The appearance findings (with overlap) included reticular in four cases (30.8 %), ground-glass opacities in two cases (15.4 %), patchy in 10 cases (76.9 %), and three cases (23.1 %) had nodular collections (23.1 %). CRP and P-SEP could not be measured in one case each, due to high viscosity. Of the 12 cases, all CRP levels exceeded the normal range, while P-SEP levels were normal in two cases (16.7 %).

This study highlights limitations in diagnosing pneumonia solely using PMCT and blood tests. However, CT-guided postmortem biopsy facilitates the identification of pneumonia even when inflammatory findings are not detectable by PMCT and blood tests.