title: Possibility of visualization of gastrothorax based on unenhanced postmortem computed tomography/PMCT.
abstract: We present a fatal case of a gastrothorax due to an acute gastric volvulus resulting from a Bochdalek hernia. A 5-year-old boy without previous medical history was brought to our institution in a state of cardiopulmonary arrest and was subsequently pronounced dead. Postmortem computed tomography (PMCT) of the torso showed abdominal organs involving the lower section of the esophagus up to the entire stomach, the left side of the transverse colon, the entire spleen, and the tail of the pancreas herniated into the left thoracic cavity. The stomach was markedly expanded and a mesentero-axial (rotation along the short axis) volvulus was observed, displacing mediastinal structures to the right side and depressing the diaphragmatic contour. A PMCT of the thorax at the lung window setting revealed displacement of bilateral lungs. The bilateral lungs were severely atelectatic and congested. The PMCT findings mentioned above were consistent with the autopsy findings. PMCT can provide useful information for the diagnosis in cases we initially cannot predict any significant changes, for example, organ displacement.
authors.affiliation: Department of Legal Medicine, Nippon Medical School, Tokyo, Japan; Tsukuba Medical Examiner's Office, Tsukuba, Japan. Electronic address: ta-okuda@nms.ac.jp.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Okuda
authors.affiliation: Department of Radiology, Seirei Fuji Hospital, Fuji, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shiotani
authors.affiliation: Department of Radiological Technology, Tsukuba Medical Center, Tsukuba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Legal Medicine, Nippon Medical School, Tokyo, Japan; Tsukuba Medical Examiner's Office, Tsukuba, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hayakawa
authors.affiliation: Department of Legal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Youkichi
authors.initials: Y
authors.lastname: Ohno
mesh_terms: D001344:Autopsy / Q000379:methods*; D002675:Child, Preschool; D049429:Forensic Pathology; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D011859:Radiography; D012422:Rupture, Spontaneous; D013277:Stomach Volvulus / Q000000981:diagnostic imaging* / Q000473:pathology; D015898:Tomography Scanners, X-Ray Computed
keywords: Congenital diaphragmatic hernia; Forensic pathology; Gastric volvulus; PMCT; Sudden death; Tension gastrothorax