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Published on: September 27, 2020
The relationship between hypostasis and gas detected in postmortem computed tomography and the postmortem interval
Vefa Çakmak1, Abdülkadir İzci2, Tuğçe Dönmez1
1Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Türkiye.
Purpose:
To evaluate the relationship between gas detected in solid organs, such as the aorta and heart, and hypostasis in the lung parenchyma on postmortem computed tomography (PMCT) in relation to the postmortem interval (PMI).
Methods:
Between January 2021 and January 2025, 74 individuals (60 men, 14 women; 18-84 years; mean age, 41.8 ± 17.6 years) who underwent autopsy due to various forensic causes were retrospectively evaluated using PMCT images obtained prior to autopsy. The presence of gas in the heart, liver, kidneys, and aorta on postmortem thoracic and abdominal CT images was graded as follows: grade 0, absent; grade 1, ≤ 25%; grade 2, > 25% but < 50%; and grade 3, ≥ 50%. These findings were compared with the PMI. In addition, the presence of hypostasis and clotting in the lungs on thoracic PMCT was compared with the PMI.
Results:
Intravascular gas was observed within the cardiac chambers in all but seven cases, and the amount of intracardiac gas increased in direct proportion to the PMI. The presence of clotting in the pulmonary arteries showed a statistically significant association with the PMI (P = 0.015). A strong positive correlation (r: 0.720) was identified between intravascular gas in the liver and that in the cardiac chambers. Furthermore, a statistically significant and strong positive correlation was found between pulmonary hypostasis and clotting in the pulmonary arteries (r: 0.892, P = 0.001). A strong correlation was also observed between pulmonary arterial clotting and the density differences between hypostatic and non-hypostatic regions of the lung parenchyma (r: 0.918).
Conclusion:
On PMCT, decomposition-related gas can be detected in solid organs, particularly in the liver and heart, as early as within 48 hours postmortem, and its presence is associated with the PMI. A strong correlation exists between pulmonary arterial clotting or sedimentation and hypostasis in the lung parenchyma.
Clinical Significance:
PMCT can help determine the PMI, in addition to identifying forensic causes of death, and may contribute to routine forensic assessment.
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