Identification of gas accumulations in the bodies of fetuses, still-borns and dead newborns at postmortem computed tomography study

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Abstract

Posthumous computed tomography (CT) requires the differential diagnosis of postmortem and antemortem pathological processes. The most important is the issue with respect to detection of gas concentrations, as the traditional autopsy study does not allow to fully reveal the presence of intravascular intraorganic or gas except in severe air embolism. Purpose of the study. To explore the features of gas accumulation in organs and tissues of the dead fetuses, stillbirths and deaths of newbornswith the help of postmortem CT localization. Materials and methods. Examie via postmortem CT 110 fetuses, stillbirths and deaths of newborns. All observations were divided into five groups. Two groups consisted of fetuses after spontaneous (group 1, n=9) or induced abortion (group 2, n=41) on 14-21 th week of gestation. The two groups accounted body stillborn, died at gestational age 25-39 weeks prenatally (group 3, n=15) with the prescription of fetal death from 14 hours to 2 weeks or intrapartum (group 4, n=3). The 5th group included bodies of 42 infants born at 24-40 weeks and the timing of deaths between the ages of 6 hours to 166 days. After CT studies post mortem examination followed by an analysis of histological slides of tissue and organswas performed. Results. Rarer air accumulations were observed at postmortem CT baby bodies after induced (14.6%) and spontaneous (11.1%) of abortions. The most common gas visualized in cases of intrapartum death and the dead babies. On tomograms of bodies of newborns who died intrapartum, gas was visualized in all 3 cases. Only 5 (11.9%) died of gas accumulations newborn have not been determined. Conclusions. Posthumous CT is a more efficient method of detection of gas concentrations in comparison with the autopsy, however, cannot fully be an alternative to the traditional autopsy studies to carry out a comprehensive macroscopic and microscopic examination of organs and tissues.

About the authors

U. N Tumanova

V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation

Email: u.n.tumanova@gmail.com
канд. мед. наук, науч. сотр. патологоанатомического отд-ния ФГБУ НЦАГиП им. акад. В.И.Кулакова 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4

V. K Fedoseeva

V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation

мл. науч. сотр. отд-ния лучевой диагностики ФГБУ НЦАГиП им. акад. В.И.Кулакова 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4

V. M Lyapin

V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation

врач-патологоанатом патологоанатомического отд-ния ФГБУ НЦАГиП им. акад. В.И.Кулакова 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4

A. I Shchegolev

V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation

д-р мед. наук, проф., зав. патологоанатомическим отд-нием ФГБУ НЦАГиП им. акад. В.И.Кулакова 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4

G. T Sukhikh

V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation

акад. РАН, д-р мед. наук, проф., дир. ФГБУ НЦАГиП им. акад. В.И.Кулакова 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4

References

  1. Roberts I.S, Benamore R.E, Benbow E.W et al. Post - mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 2012; 379: 136-42.
  2. Щеголев А.И., Туманова У.Н. Роль магнитно - резонансной томографии в определении танатогенеза. Криминалистика: прошлое, настоящее, будущее: достижения и перспективы развития. М.: Академия Следственного комитета Российской Федерации, 2014; 369-72.
  3. Thali M.J, Yen K, Schweizer W et al. Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) a feasibility study. J Forensic Sci 2003; 48: 386-403.
  4. Dirnhofer R, Jackowski C, Vock P et al. VIRTOPSY: minimally invasive, imaging guided virtual autopsy. Radio Graphics 2006; 26: 1305-33.
  5. Thali M.J, Jackowski C, Oesterhelweg L et al. Virtopsy - the Swiss virtual autopsy approach. Leg Med (Tokyo) 2007; 9: 100-4.
  6. Charlier P, Carlier R, Roffi F et al. Postmortem abdominal CT: assessing normal cadaveric modifications and pathological processes. Eur J Radiol 2011; 81 (4): 639-47.
  7. Туманова У.Н., Федосеева В.К., Ляпин В.М. и др. Плод - акардиус: посмертная компьютерная и магнитно - резонансная томография. Диагностическая и интервенционная радиология. 2016; 2: 20-3.
  8. Коков Л.С., Кинле А.Ф., Синицын В.Е., Филимонов Б.А. Возможности компьютерной и магнитно - резонансной томографии в судебно - медицинской экспертизе механической травмы и скоропостижной смерти (обзор литературы). Журн. им. Н.В.Склифосовского. Неотложная медицинская помощь. 2015; 2: 16-26.
  9. Sogawa N, Michiue T, Kawamoto O et al. Postmortem virtual volumetry of the heart and lung in situ using CT data for investigating terminal cardiopulmonary pathophysiology in forensic autopsy. Leg Med (Tokyo) 2014; 16: 187-92.
  10. Arthurs O.J, Guy A, Thayyil S et al. Comparison of diagnostic performance for perinatal and paediatric post - mortem imaging: CT versus MRI. Eur Radiol 2016; 26 (7): 2327-36.
  11. Туманова У.Н., Федосеева В.К., Ляпин В.М. и др. Посмертная компьютерная томография мертворожденных с костной патологией. Медицинская визуализация. 2013; 5: 110-20.
  12. Фетисов В.А., Куприна Т.А., Синицын В.Е. и др. Зарубежный опыт использования современных методов лучевой диагностики в решении вопросов давности наступления смерти и причинения повреждений. Судебно - медицинская экспертиза. 2016; 2: 47-54.
  13. Туманова У.Н., Щеголев А.И. Лучевая визуализация неспецифических посмертных изменений сердечно - сосудистой системы. Судебно - медицинская экспертиза. 2016; 5: 59-63.
  14. Pedal I, Moosmayer A, Mallach H.J et al. Air embolism or putrefaction? Gas analysis findings and their interpretation. Z Rechtsmed 1987; 99: 151-67.
  15. Sakata M, Miki A, Kazama H et al. Studies on the composition of gases in the post - mortem body: animal experiments and two autopsy cases. Forensic SciInt 1980; 15: 19-29.
  16. Jackowski C, Sonnenschein M, Thali M.J et al. Intrahepatic gas at postmortem computed tomography: forensic experience as a potential guide for in vivo trauma imaging. J Trauma 2007; 62: 979-88.
  17. Singh M.K, O’Donnell C, Woodford N.W. Progressive gas formation in a deceased person during mortuary storage demonstrated on computed tomography. Forensic Sci Med Pathol 2009; 5: 236-42.
  18. Мишнев О.Д., Щеголев А.И., Трусов О.А. Патолого - анатомическая диагностика сепсиса. Сепсис в начале XXI века. Классификация, клинико - диагностическая концепция и лечение. Патолого - анатомическая диагностика. М.: Изд - во НЦССХ им. А.Н.Бакулева РАМН, 2004; с. 111-26.
  19. Perper J.A. Time of death and changes after death: part 1. Anatomical considerations. In: Spitz W.U, Spitz D.J (ed.). Medicolegal investigationof death. 4th ed. Springifield, IL: CC Thomas, 2005: 107-8.
  20. Павлов К.А., Дубова Е.А., Бурдули Г.М. и др. Мацерация плода. Акушерство и гинекология. 2012; 2: 115-9.
  21. Tumanova U.N, Lyapin V.M, Voevodin S.M et al. Postmortem MRI to determine the time of intrauterine fetal death. Virchows Archiv 2015; 467 (Suppl. 1): S27.
  22. Voevodin S.M, Tumanova U.N, Liapin V.M et al. Postmortem MRI as a method of evaluating the degree of maceration at intrauterine fetal death. Insightsinto Imaging 2016; 7 (S1): 354.
  23. Щеголев А.И., Туманова У.Н., Шувалова М.П., Фролова О.Г. Гипоксия как причина мертворождаемости в Российской Федерации. Здоровье, демография, экология финно - угорских народов. 2014; 3: 96-8.
  24. Щеголев А.И., Туманова У.Н., Шувалова М.П., Фролова О.Г. Сравнительный анализ мертворождаемости в Российской Федерации в 2010 и 2012 годах. Рос. вестн. перинатологии и педиатрии. 2015; 3: 58-62.
  25. Atake S, Yamazaki K, Nakayama H. Cardiovascular gas on non - traumatic postmortem computed tomography (PMCT): the influence of cardiopulmonary resuscitation. Radiat Med 2005; 23: 225-9.
  26. Takahashi N, Higuchi T, Shiotani M et al. Intrahepatic gas at postmortem multislice computed tomography in cases of nontraumatic death. Jpn J Radiol 2009; 27: 264-8.
  27. Hwang S.L, Lieu A.S, Lin C.L et al. Massive cerebral air embolism after cardiopulmonary resuscitation. J Clin Neurosci 2005; 12: 468-9.
  28. Sowell M.W, Lovelady C.L, Brogdon B.G, Wecht C.H. Infant death due to air embolism from peripheral venous infusion. J Forensic Sci 2007; 52: 183-8.
  29. Adams V, Guidi С. Venous air embolism in homicidal blunt impact headtrauma. Case reports. Am J Forensic Med Pathol 2001; 22: 322-6.
  30. Brown Z.A, Clark J.M, Jurg A.L. Systemic gas embolus. A discussion of its pathogenesis in the neonate with a review of the literature. Am J Dis Chest 1977; 131: 994-1005.
  31. Swartz N, Eisenkraft J.B. Probable venous air embolism during epidural placement in an infant. Anesth Analg 1993; 76: 1136-8.
  32. Wald M, Kirchner L, Lawrenz K, Amann G. Fatal air embolism in anextremely low birth weight infant: can it be caused by intravenous injectionsduring resuscitations? Intensive Care Med 2003; 29: 630-3.
  33. Туманова У.Н., Щеголев А.И. Неспецифические посмертные изменения, выявляемые при компьютерно - томографическом исследовании. Криминалистическое сопровождение расследования преступлений: проблемы и пути их решения. М.: Академия Следственного комитета Российской Федерации, 2016; с. 525-9.
  34. Ольхова Е.Б. Газ портальной системы у младенцев. Медицинская визуализация. 2014; 5: 34-44.

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