title: Can ruptured abdominal aortic aneurysm be accurately diagnosed as the cause of death without postmortem computed tomography when autopsies cannot be performed?
abstract: OBJECTIVE
  This study aimed to conduct a multicentre retrospective review of cases to clarify how many ruptured abdominal aortic aneurysms (RAAAs) as the cause of death could be diagnosed without post-mortem computed tomography (PMCT) when autopsies cannot be performed.
  
  
  METHODS
  We collected consecutive PMCT data from January 2002 to December 2009 from three institutes where PMCT examinations are performed on a routine basis for deceased patients with unknown causes of death. A total of 19 cases were identified where PMCT revealed RAAAs. Ante-mortem clinical presentations, post-mortem external examinations, and peri-mortem ultrasonography findings were assessed for their diagnostic accuracy.
  
  
  RESULTS
  The correct diagnosis based on the classic triad of shock, acute abdominal pain, and pulsatile abdominal mass was made in only one of 19 (5.3%) patients. Shock, acute abdominal pain, and abdominal swelling were found in five of 19 (26%) patients. Shock and acute abdominal pain or abdominal swelling were found in two of 19 (10%) patients. Ten of 19 (53%) patients only had shock. Peri-mortem ultrasonography was performed in seven of 19 patients; one was diagnosed with RAAA (14%). No patients had pre-mortem CT examinations.
  
  
  CONCLUSIONS
  Post-mortem diagnosis of RAAA is difficult to make based on ante-mortem clinical presentation, post-mortem external examinations, or peri-mortem ultrasonography. PMCT is recommended for diagnosing RAAA as the cause of death if pre-mortem CT examinations are not carried out when autopsies cannot be performed.
authors: Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: ymakino-tky@umin.ac.jp.
authors: Yohsuke
authors: Y
authors: Makino
authors: Autopsy Imaging Information Center, 4-6-10 Ginza, Chuo-ku, Tokyo 104-0061, Japan. Electronic address: seikichi@autopsyimaging.com.
authors: Seiji
authors: S
authors: Yamamoto
authors: Department of Radiology, Tsukuba Medical Center, 1-3-1 Amakubo, Tsukuba 305-8558, Japan. Electronic address: shiotani@tmch.or.jp.
authors: Seiji
authors: S
authors: Shiotani
authors: Department of Forensic Medicine, Tsukuba Medical Examiner's Office, 1-3-1 Amakubo, Tsukuba 305-8558, Japan. Electronic address: hayakawa@tmch.or.jp.
authors: Hideyuki
authors: H
authors: Hayakawa
authors: Department of Radiology, Numazu City Hospital, 550 Harunoki-aza, Higashishiiji, Numazu, Shizuoka 410-0302, Japan. Electronic address: hfujimot@lilac.ocn.ne.jp.
authors: Hajime
authors: H
authors: Fujimoto
authors: Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan. Electronic address: rd8h-ykt@radio.ne.jp.
authors: Hajime
authors: H
authors: Yokota
authors: Department of Diagnostic Radiology and Radiation Oncology, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: taku_steelfish@yahoo.co.jp.
authors: Takuro
authors: T
authors: Horikoshi
authors: Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: iwase@faculty.chiba-u.jp.
authors: Hirotaro
authors: H
authors: Iwase
authors: Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Diagnostic Radiology and Radiation Oncology, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: unotakas@faculty.chiba-u.jp.
authors: Takashi
authors: T
authors: Uno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D001019:Aortic Rupture / Q000000981:diagnostic imaging*; D001344:Autopsy; D002423:Cause of Death; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Abdominal aortic aneurysm; Autopsy; Cause of death; Multidetector computed tomography; Ruptured aortic aneurysm