Can cervical spine injury be correctly diagnosed by postmortem computed tomography?
We discuss the usefulness of postmortem computed tomography (PMCT) by reviewing cases of cervical spine injury. A merit of PMCT is that it can identify injury that cannot be found on autopsy; however, peculiar defects of it may exist. While PMCT can identify bone fractures, it cannot indicate whether the injury was inflicted while the deceased was still alive or not because of its inability to clearly image bleeding around the fracture. Furthermore, CT often misses some types of cervical spine injuries, such as laceration of an intervertebral disk and incomplete fracture of the cervical spine. On the other hand, cervical spine injury on CT images occasionally has an appearance similar to subarachnoid hemorrhage due to rupture of the cerebral artery, indicating that cervical spine injury can be misdiagnosed as a disease by PMCT. When PMCT is used for screening trauma, caution must be observed regarding its limitations. If the possibility of trauma of the neck or head is not completely ruled out from the personal history of the victim, autopsy is strongly recommended, even when PMCT findings indicate that the cause of death may be due to disease, such as subarachnoid hemorrhage.
Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan. iwase@faculty.chiba-u.jp
Hirotaro
H
Iwase
Seiji
S
Yamamoto
Daisuke
D
Yajima
Mutsumi
M
Hayakawa
Kazuhiro
K
Kobayashi
Katsura
K
Otsuka
Kaoru
K
Sato
Hisako
H
Motani
Shiori
S
Kasahara
Hisao
H
Ito
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D003951:Diagnostic Errors; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007403:Intervertebral Disc / Q000293:injuries / Q000473:pathology; D022125:Lacerations; D008297:Male; D008875:Middle Aged; D012887:Skull Fractures / Q000000981:diagnostic imaging; D013124:Spinal Injuries / Q000175:diagnosis*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed