Postmortem computed tomography and nasopharyngeal fiberscopic findings in aspiration asphyxia

Recently, postmortem computed tomography has been utilized in forensic practice, but reports on postmortem computed tomography imaging findings for the diagnosis of aspiration asphyxia remain scarce. In emergency settings, aspiration asphyxia is suspected based on the symptoms and physical examination findings, and endoscopic examination is used to confirm the presence of foreign bodies in the airway. In the present study, we performed both endoscopic examination and postmortem CT imaging on cadavers and investigated the usefulness of combining these techniques for determining the cause of death in cases of aspiration asphyxia. Among the 2772 autopsy cases examined at our department between July 2010 and December 2023, the cause of death in 15 cases was aspiration asphyxia. Postmortem CT showed foreign body filling of the pharynx and esophagus, along with esophageal dilatation. Postmortem endoscopy confirmed the presence of foreign bodies in the pharynx, larynx, and trachea; however, visualization was difficult in some cases. In conclusion, postmortem CT and endoscopy could confirm the presence of foreign bodies in the airways prior to autopsy and may aid in the diagnosis of food aspiration asphyxia. However, in some cases, adequate findings may not be obtained, necessitating the consideration of autopsy findings to identify the cause of death.