title: Postmortem CT versus forensic autopsy: frequent discrepancies of tracheobronchial content findings.
abstract: In their daily forensic casework, the authors experienced discrepancies of tracheobronchial content findings between postmortem computed tomography (PMCT) and autopsy to an extent previously unnoticed in the literature. The goal of this study was to evaluate such discrepancies in routine forensic cases. A total of 327 cases that underwent PMCT prior to routine forensic autopsy were retrospectively evaluated for tracheal and bronchial contents according to PMCT and autopsy findings. Hounsfield unit (HU) values of tracheobronchial contents, causes of death, and presence of pulmonary edema were assessed in mismatching and matching cases. Comparing contents in PMCT and autopsy in each of the separately evaluated compartments of the respiratory tract low positive predictive values were assessed (trachea, 38.2%; main bronchi, 40%; peripheral bronchi, 69.1%) indicating high discrepancy rates. The majority of tracheobronchial contents were viscous stomach contents in matching cases and low radiodensity materials (i.e., HU < 30) in mismatching cases. The majority of causes of death were cardiac related in the matching cases and skull/brain trauma in the mismatching cases. In mismatching cases, frequency of pulmonary edema was significantly higher than in matching cases. It can be concluded that discrepancies in tracheobronchial contents observed between PMCT and routine forensic autopsy occur in a considerable number of cases. Discrepancies may be explained by the runoff of contents via nose and mouth during external examination and the flow back of tracheal and main bronchial contents into the lungs caused by upright movement of the respiratory tract at autopsy.
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland. Wolf-Dieter.Zech@irm.unibe.ch.
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Zech
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Schwendener
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Brencicova
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.|Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Freiburgstrasse 10, Bern, CH-3010, Switzerland.
authors.forename: Frederick
authors.initials: F
authors.lastname: Schuster
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.|Department of Diagnostic Imaging and Radiotherapy of the University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lombardo
mesh_terms: D001344:Autopsy; D001980:Bronchi / Q000473:pathology*; D001995:Bronchography; D005260:Female; D049429:Forensic Pathology; D005766:Gastrointestinal Contents / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000473:pathology; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Aspiration; Discrepancy; Forensic radiology; PMCT; Tracheobronchial content