A new approach in virtopsy: Postmortem ventilation in multislice computed tomography

Germerott, Tanja; Preiss, Ulrich S.; Ebert, Lars C.; Ruder, Thomas D.; Ross, Steffen; Flach, Patricia M.; Ampanozi, Garyfalia; Filograna, Laura; Thali, Michael J.

doi:10.1016/j.legalmed.2010.07.001

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Volume 12, Issue 6 , Pages 276-279, November 2010

A new approach in virtopsy: Postmortem ventilation in multislice computed tomography

Tanja Germerott
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
- Corresponding author. Address: Institute of Legal Medicine, University of Berne, Bühlstrasse 20, 3012 Berne, Switzerland. Tel.: +41 31 631 3049; fax: +41 31 631 3833.
Ulrich S. Preiss
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
Lars C. Ebert
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
Thomas D. Ruder
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
Steffen Ross
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
- Inselspital Berne, Institute of Diagnostic, Interventional and Paediatric Radiology, University of Berne, Berne, Switzerland
Patricia M. Flach
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
- Inselspital Berne, Institute of Diagnostic and Interventional Neuroradiology, University of Berne, Berne, Switzerland
Garyfalia Ampanozi
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
Laura Filograna
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland
Michael J. Thali
- Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Berne, Berne, Switzerland

Received 15 March 2010; received in revised form 19 May 2010; accepted 15 July 2010. published online 23 August 2010.

Abstract

Although postmortem imaging has gained prominence in the field of forensic medicine, evaluation of the postmortem lung remains problematic. Specifically, differentiation of normal postmortem changes and pathological pulmonary changes is challenging and at times impossible.

In this study, five corpses were ventilated using a mechanical ventilator with a pressure of 40mbar (40.8cm H₂O). The ventilation was performed via an endotracheal tube, a larynx mask or a continuous positive airway pressure mask. Postmortem computed tomographic images of the lungs before and with a ventilation of 40mbar (40.8cm H₂O) were evaluated and the lung volumes were measured with segmentation software.

Postmortem ventilation led to a clearly visible decrease of both the density in the dependant parts of the lungs and ground glass attenuation, whereas consolidated areas remained unchanged. Furthermore, a mean increase in the lung volume of 2.10l was seen. Pathological changes such as septal thickening or pulmonary nodules in the lung parenchyma became more detectable with postmortem ventilation.

Intracorporal postmortem mechanical ventilation of the lungs appears to be an effective method for enhancing detection of small pathologies of the lung parenchyma as well as for discriminating between consolidation, ground glass attenuation and position-dependent density.

Keywords: Postmortem ventilation, Forensic imaging, Virtopsy, Imaging of the lungs