title: Distribution of artifactual gas on post-mortem multidetector computed tomography (MDCT).
abstract: OBJECTIVE
  We investigated the incidence and distribution of post-mortem gas detected with multidetector computed tomography (MDCT) to identify factors that could distinguish artifactual gas from cardiac air embolism.
  
  
  METHODS
  MDCT data of 119 cadavers were retrospectively examined. Gas was semiquantitatively assessed in selected blood vessels, organs, and body spaces (82 total sites).
  
  
  RESULTS
  Seventy-four of the 119 cadavers displayed gas (62.2%; CI 95% 52.8-70.9), and 56 (75.7%) displayed gas in the heart. Most gas was detected in the hepatic parenchyma (40%), right heart (38% ventricle, 35% atrium), inferior vena cava (30% infrarenally, 26% suprarenally), hepatic veins (26% left, 29% middle, 22% right), and portal spaces (29%). Male cadavers displayed gas more frequently than female cadavers. Gas was detected 5-84 hours after death; therefore, the post-mortem interval could not reliably predict gas distribution (rho = 0.719, p < 0.0001). We found that a large amount of putrefaction-generated gas in the right heart was associated with aggregated gas bubbles in the hepatic parenchyma (sensitivity = 100%, specificity = 89.7%). In contrast, gas in the left heart (sensitivity = 41.7%, specificity = 100%) or in periumbilical subcutaneous tissues (sensitivity = 50%, specificity = 96.3%) could not predict gas due to putrefaction.
  
  
  CONCLUSIONS
  This study is the first to show that the appearance of post-mortem gas follows a specific distribution pattern. An association between intracardiac gas and hepatic parenchymal gas could distinguish between post-mortem-generated gas and vital air embolism. We propose that this finding provides a key for diagnosing death due to cardiac air embolism.
authors.affiliation: University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Lausanne CH-1011, Switzerland. Coraline.Egger@unil.ch
authors.forename: Coraline
authors.initials: C
authors.lastname: Egger
authors.forename: Pierre
authors.initials: P
authors.lastname: Bize
authors.forename: Paul
authors.initials: P
authors.lastname: Vaucher
authors.forename: Pascal
authors.initials: P
authors.lastname: Mosimann
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schneider
authors.forename: Alejandro
authors.initials: A
authors.lastname: Dominguez
authors.forename: Reto
authors.initials: R
authors.lastname: Meuli
authors.forename: Patrice
authors.initials: P
authors.lastname: Mangin
authors.forename: Silke
authors.initials: S
authors.lastname: Grabherr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002102:Cadaver; D004618:Embolism, Air / Q000000981:diagnostic imaging; D005260:Female; D005740:Gases; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011180:Postmortem Changes; D055815:Young Adult
chemical_list: D005740:Gases