Postmortem computed tomography in victims of military air mishaps: radiological-pathological correlation of CT findings.
A thorough medical inquiry is included in every aviation mishap investigation. While the gold standard of this investigation is a forensic pathology examination, numerous reports stress the important role of computed tomography in the postmortem evaluation of trauma victims. To characterize the findings identified by postmortem CT and compare its performance to conventional autopsy in victims of military aviation mishaps, we analyzed seven postmortem CT examinations. Musculoskeletal injuries accounted for 57.8% of the traumatic findings identified by postmortem CT. The most frequent findings were fractures of the rib (47%), skull (9.6%) and facial bones (8.6%). Abnormally located air accounted for 24% of findings, for which CT was superior (3.5% detected by autopsy, 100% by postmortem CT, P < 0.001). The performance of autopsy in detecting injuries was superior (autopsy detected 85.8% of all injuries, postmortem CT detected 53.9%, P < 0.001), especially in the detection of superficial lesions (100% detected by autopsy, 10.5% by postmortem CT, P < 0.001) and solid organ injuries (100% by autopsy, 18.5% by postmortem CT, P < 0.001). Performance in the detection of musculoskeletal injuries was similar (91.3% for autopsy, 90.3% for postmortem CT, P = not significant). Postmortem CT and autopsy have distinct performance profiles, and although the first cannot replace the latter it is a useful complementary examination.
Levy
Gad
G
Headquarters of the Israeli Air Force Surgeon General, Tel Hashomer, Israel. gad.levy@gmail.com
Goldstein
Liav
L
Blachar
Arye
A
Apter
Sara
S
Barenboim
Erez
E
Bar-Dayan
Yaron
Y
Shamis
Ari
A
Atar
Eli
E
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D000060:Accidents, Aviation / Q000517:prevention & control / Q000706:statistics & numerical data*; D000401:Aircraft / Q000592:standards*; D001344:Autopsy; D002423:Cause of Death; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000473:pathology; D049429:Forensic Pathology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008887:Military Medicine / Q000295:instrumentation / Q000379:methods*; D008889:Military Personnel; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology