Abdominal CT findings on the day of death in patients with solid organ malignancies

Evidence on imaging of imminent death could complement clinical and laboratory predictors, provide insight into the biology of dying, and possibly help clinicians advise patient families. The purpose of this study was to identify findings on abdominopelvic CT that are associated with imminent death in patients with solid organ malignancies.

The electronic record was searched over a ten-year period for patients with solid organ cancers who had an abdominopelvic CT within 24 h of death and at least one prior CT. The CT studies of 28 patients were evaluated for third-spacing (pleural fluid, ascites, anasarca), body wall fat attenuation, psoas muscle attenuation, and psoas muscle size. Imaging findings were compared to laboratory values obtained at the time of the scans; these included sodium, creatinine, alkaline phosphatase, bilirubin, hemoglobin, white blood cell count, neutrophil count, and prealbumin. Statistical analysis included the Wilcoxon signed rank test for changes in third-spacing scores and linear regression for all other variables.

Third-spacing scores increased significantly on CT examinations obtained within 24 h of death compared with prior CT examinations (p < 0.0001), driven primarily by increases in pleural effusions and anasarca. Measurements of ascites, psoas muscle size, psoas attenuation, and body wall fat attenuation were not significantly associated with proximity to death. Among laboratory values, only neutrophil count increased significantly (p = 0.03).

Marked increases in pleural effusions and anasarca were observed on CT examinations obtained within 24 h of death in this cohort of patients with advanced solid organ malignancies. The specificity of these findings for imminent death would require validation in controlled prospective studies.