scholarly journals Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

2019 ◽  
Vol 134 (4) ◽  
pp. 1457-1463
Author(s):  
M. E. M. Vester ◽  
R. R. van Rijn ◽  
W. L. J. M. Duijst ◽  
L. F. M. Beenen ◽  
M. Clerkx ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Medical Records ◽  
Clinical Findings ◽  
Added Value ◽  
Post Mortem ◽  
Additional Information ◽  
Organ Failures ◽  
Total Body ◽  
Underlying Diseases

Abstract Purpose The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners’ (GP), out-of-hospital population. Methods and materials Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. Results Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP’s responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36–99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. Conclusion PMCT can have added value for the detection of additional findings regarding the cause of death in an out-of-hospital, GP’s population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

Computed Tomography for Minor Head Injury

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
New Orleans ◽  
Clinical Findings ◽  
Minor Head Injury ◽  
Ct Scans ◽  
Clinical Implications ◽  
Clinical Context ◽  
Additional Information ◽  
Study Methodology

This chapter, found in the headache section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) scans for minor head injury using the New Orleans criteria. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that head CT scans for patients with minor head injury can be safely limited to those presenting with at least 1 of 7 specific clinical findings. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

Identifying the correct cause of death: The role of post-mortem computed tomography in sudden unexplained death

2014 ◽  
Vol 2 (4) ◽  
pp. 210-212
Author(s):  
Matthew Clarke ◽  
Angus McGregor ◽  
Claire Robinson ◽  
Jasmin Amoroso ◽  
Bruno Morgan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Post Mortem ◽  
Sudden Unexplained Death ◽  
Unexplained Death

scholarly journals Echoskopijos ir kompiuterinės tomografijos reikšmė diagnozuojant ūminį apendicitą

2003 ◽  
Vol 1 (3) ◽  
pp. 0-0
Author(s):  
Raminta Šydeikienė ◽  
Jūratė Dementavičienė ◽  
Aurelijus Grigaliūnas
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Contrast Material ◽  
Clinical Findings ◽  
Lower Quadrant ◽  
Additional Information ◽  
Emergent Surgery ◽  
Suspected Acute Appendicitis

Raminta Šydeikienė1, Jūratė Dementavičienė2, Aurelijus Grigaliūnas11 Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-2043 Vilnius,2 Vilniaus universiteto ligoninė "Santariškių klinikos",Santariškių g. 2, LT-2021 VilniusEl paštas: [email protected] Įvadas / tikslas Ūminio apendicito diagnozę dažniausiai galima tiksliai nustatyti pagal klinikinius požymius ir sėkmingai taikyti chirurginį gydymą. Tačiau apie 20–30% operacinių radinių nepatvirtina ūminio apendicito diagnozės – kirmėlinė atauga būna nepakitusi. Todėl neaiškiais klinikiniais atvejais turėtų būti taikomas nuodugnesnis ligonio ištyrimas prieš operaciją, kad galėtume nustatyti skausmo dešiniajame apatiniame pilvo kvadrante priežastį. Mūsų tyrimo tikslas – nustatyti ultragarso (UG) ir kompiuterinės tomografijos (KT) reikšmę diagnozuojant ūminį apendicitą. Ligoniai ir metodai Kiekvienais metais Vilniaus greitosios pagalbos universitetinės ligoninės Bendrosios chirurgijos centre operuojama apie 750 ligonių, kuriems diagnozuojamas ūminis apendicitas. Nuo 2000 m. iki 2003 m. pirmojo pusmečio pabaigos 225 ligoniams, tirtiems ultragarsu, buvo nustatyta ūminio apendicito diagnozė. Mūsų ligoninėje operuoti 193 ligoniai (85,78%), iš jų 101 moteris ir 92 vyrai (amžius nuo 16 iki 80 metų). Rezultatai Iš 225 ligonių, kuriems ultragarsu buvo nustatyta ūminio apendicito diagnozė, mūsų ligoninėje operuoti 193 (85,78%). 32 ligoniams (14,22%) chirurginis gydymas nebuvo taikytas. Operacijos radiniai su UG nesutapo 44 atvejais (22,8%), iš kurių 20 atvejų (10,4%) buvo diagnozuotas katarinis apendicitas, 24 atvejais (12,4%) – kita patologija: divertikulitas, Krono liga, pūlinis adneksitas, aklosios ir storosios žarnų navikai ir kt. 149 ligoniams (77,20%) nustatyta ūminio apendicito diagnozė, iš jų 82 (42,49%) – flegmoninis apendicitas, 25 (12,95%) – gangreninis apendicitas, 42 (21,76%) – gangreninis perforacinis apendicitas ir apendikulinis abscesas. Kompiuterinė tomografija buvo atlikta 43 ligoniams, kuriems ūminio apendicito klinika, subjektyvūs skundai, objektyvių tyrimų duomenys ir ligos eiga buvo ne visai tipiški, o UG tyrimu diagnozė nenustatyta. Šešiolikai ligonių buvo patvirtinta ūminio ar ūminio komplikuoto apendicito diagnozė, 10 ligonių pokyčių nerasta, o 17 ligonių diagnozuotos kitos ligos. Išvados Pilvo dešiniojo apatinio kvadranto skausmą gali sukelti daugelis ūminių ligų. Kai klinikiniai radiniai yra abejotini, turėtų būti atliekamas ultragarsinis tyrimas. Tais atvejais, kai diagnozė lieka neaiški, būtina atlikti pilvo ir dubens kompiuterinę tomografiją. Prasminiai žodžiai: ūminis apendicitas, ultragarsinis tyrimas (UG), sonoskopija, kompiuterinė tomografija (KT). The value of ultrasonography and computed tomography in diagnosing acute appendicitis Raminta Šydeikienė1, Jūratė Dementavičienė2, Aurelijus Grigaliūnas1 Background / objective The purpose of our study was to determine the role of US and CT in differential diagnosis of suspected acute appendicitis. In most cases the clinical findings are reliable for correct diagnosis and emergent surgery due to acute appendictitis. Nevertheless, 20–30% of operation findings do not confirm the diagnosis of acute appendicitis (normal appendix is found). In some cases additional examinations should be done prior to surgery. Patients and methods Every year almost 750 patients with acute appendicitis are operated on at Vilnius University Emergency Hospital. 225 patiens were examined with US for suspected acute appendicitis in the period 2000–half 2003. In 193 cases (85.78%) patients were operated on. Sex: 101 F, 92 M. The age varied from 16 to 80 years. By CT, 43 patients were examined. In all cases helical unenhanced CT was performed, with collimation 8 mm and table feed 12 mm. In the cases when differential diagnosis was necessary, 50 ml of 300 g/ml J nonionic contrast material was injected i/v (by hand). Results For suspected acute appendicitis 225 patients were examined with US. In 193 cases (85.78%) patients were operated on. In 32 cases (14.22%) no emergent surgery was performed in our hospital. The disagreement of findings was in 44 cases (22.8%), where in 20 cases (10.4%) appendicitis catarrhalis and in 24 cases (12.4%) other pathology (coecum, colon tumor, Crohn’s disease, diverticulitis, adnexitis) were found. In 149 cases (77.20%) the diagnosis of acute appendicitis was confirmed, including phlegmonous in 82 cases (42.49%), gangrenous in 25 cases (12.95%), gangrenous perforated and appendiculas abscesses in 42 cases (21.76%). CT revealed acute or acute complicated appendicitis in 16 cases, no changes were found in 10 cases, other diseases were found in 17 cases. Conclusions Acute clinical presentation of the diseases in the right lower quadrant could be caused by a broad spectrum of pathologies.When clinical findings are doubtful, US should be performed. In the case when all data do not confirm the diagnosis, CT is necessary for additional information and correct diagnosis. Keywords: acute appendicitis, ultrasound (US), computed tomography (CT).

scholarly journals Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium

2015 ◽  
Vol 120 (8) ◽  
pp. 723-730 ◽  
Author(s):  
Laura Filograna ◽  
Patrick Laberke ◽  
Garyfalia Ampanozi ◽  
Wolf Schweitzer ◽  
Michael J. Thali ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Pericardial Tamponade ◽  
Post Mortem

scholarly journals Clinical Relevance of Unexpected Findings of Post-Mortem Computed Tomography in Hospitalized Patients: An Observational Study

2020 ◽  
Vol 17 (20) ◽  
pp. 7572
Author(s):  
Max G. Mentink ◽  
Bartholomeus G. H. Latten ◽  
Frans C. H. Bakers ◽  
Casper Mihl ◽  
Roger J. M. W. Rennenberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Observational Study ◽  
Cause Of Death ◽  
Clinical Relevance ◽  
Clinical Care ◽  
Hospitalized Patients ◽  
Post Mortem ◽  
Next Of Kin ◽  
Conventional Autopsy ◽  
Unexpected Findings

Background and objective: The current literature describing the use of minimally invasive autopsy in clinical care is mainly focused on the cause of death. However, the identification of unexpected findings is equally important for the evaluation and improvement of daily clinical care. The purpose of this study was to analyze unexpected post-mortem computed tomography (PMCT) findings of hospitalized patients and assess their clinical relevance. Materials and methods: This observational study included patients admitted to the internal medicine ward. Consent for PMCT and autopsy was requested from the next of kin. Decedents were included when consent for at least PMCT was obtained. Consent for autopsy was not obtained for all decedents. All findings reported by PMCT were coded with an International Classification of Diseases (ICD) code. Unexpected findings were identified and subsequently categorized for their clinical relevance by the Goldman classification. Goldman class I and III were considered clinically relevant. Additionally, correlation with autopsy results and ante-mortem imaging was performed. Results: In total, 120 decedents were included and evaluated for unexpected findings on PMCT. Of them, 57 decedents also underwent an autopsy. A total of 1020 findings were identified; 111 correlated with the cause of death (10.9%), 508 were previously reported (49.8%), 99 were interpreted as post-mortem changes (9.7%), and 302 were classified as unexpected findings (29.6%). After correlation with autopsy (in 57 decedents), 24 clinically relevant unexpected findings remained. These findings were reported in 18 of 57 decedents (32%). Interestingly, 25% of all unexpected findings were not reported by autopsy. Conclusion: Many unexpected findings are reported by PMCT in hospitalized patients, a substantial portion of which is clinically relevant. Additionally, PMCT is able to identify pathology and injuries not reported by conventional autopsy. A combination of PMCT and autopsy can thus be considered a more comprehensive and complete post-mortem examination.

scholarly journals Post-mortem computed tomography in adult non-suspicious death investigation—evaluation of an NHS based service

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20190017
Author(s):  
Claire Robinson ◽  
Aparna Deshpande ◽  
Cathy Richards ◽  
Guy Rutty ◽  
Catherine Mason ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Retrospective Review ◽  
Local Authority ◽  
Service Users ◽  
Post Mortem ◽  
Radiology Report ◽  
The Family ◽  
Death Investigation ◽  
The Cost

Objective: Post-mortem CT (PMCT) can replace autopsy in many cases of non-suspicious death. A purely NHS-based service to replace autopsy with PMCT was launched, with the cost met by the family from 2015 to 2017, and subsequently “free at the point of delivery” after local authority funding was secured. The aim of the service was to improve the experience for the families. This report describes and evaluates the service against local standards of (1) less than four day turn around, (2) cause of death given in >90% and (3) less than 10% require autopsy. Methods: A retrospective review of reports, records and emails was undertaken to collate demographics, times of different stages of the process, the outcome and comments from service users. Results: Between July 2015 and July 2018, 279 patients had PMCT scans, 67 (24.0%) in the family-funded service and 212 (76%) in the current service. 97.1% (n = 271/279) of cases had the radiology report issued by day 3 (96.8% vs 98.6% for the family funded and local authority-funded services respectively). A cause of death was given in 97.2% of scans. 2.8% of patients required autopsy. Feedback from families, coroner’s officers and undertakers has been overwhelmingly positive. Conclusion: The services exceeded local standards and met the needs of the Coroner and the families based on the feedback received. This model could be employed for similar services, but the change to the logistics and financial structures required to initiate such services remains a significant hurdle. Advances in knowledge: This is the first report of a fully NHS-based PMCT service.

Post-mortem analysis of gunshot wounds to the head and thorax in dogs by computed tomography, radiography and forensic necropsy

2020 ◽  
pp. 002580242097117
Author(s):  
Małgorzata Grela ◽  
Kinga Panasiuk-Flak ◽  
Piotr Listos ◽  
Magdalena Gryzińska ◽  
Grzegorz Buszewicz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Foreign Bodies ◽  
Imaging Techniques ◽  
Gunshot Wounds ◽  
Bone Lesions ◽  
X Rays ◽  
Post Mortem ◽  
Additional Information ◽  
Different Types ◽  
Post Traumatic

In view of the scarcity of literature data on the use of radiological imaging techniques in forensic veterinary medicine, while at the same time the number of reported crimes against animals involving the use of firearms is rising, this paper attempts to assess the usefulness of radiography and computed tomography (CT) in the post-mortem diagnosis of gunshot wounds (GSW) in comparison to classic necropsy. The design of the experiment was as follows: preparation of the research material (13 dog carcasses), shooting of the material from different distances (1.5 and 12 m, plus one contact shot to the head) and using different types of ammunition, followed by X-rays and CT scans in each case to examine the injuries resulting from the shot. The final steps of the experiment were photographic documentation and autopsy by the Virchow method. In the examined material, post-traumatic bone lesions and the presence of metallic foreign bodies were successfully imaged by both radiography and CT. GSW analysis using CT provided much better data quality and some additional information. Two general conclusions can be drawn from the results of the experiment. First, damage caused by gunshots is correlated with the calibre, initial velocity and kinetic energy of the projectile, as well as the distance from the muzzle of the gun to the object shot. Second, radiological examination is useful in preparing forensic veterinary opinions. Used as a complement to classic necropsy, they increase the possibility of an accurate post-mortem diagnosis of shooting victims.

Post-mortem computed tomography in forensic investigations of lethal gunshot incidents: is there an added value?

2019 ◽  
Vol 133 (6) ◽  
pp. 1889-1894 ◽  
Author(s):  
Rob A. T. van Kan ◽  
I. I. H. Haest ◽  
M. B. I. Lobbes ◽  
J. Kroll ◽  
S. R. Ernst ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Added Value ◽  
Post Mortem ◽  
Forensic Investigations
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