Imaging appearances in natural death
This article explores the increasing role of post‑mortem CT (PMCT) as an alternative or adjunct to traditional autopsy in cases of suspected natural death. The article explains that while coroners typically request post‑mortem investigations when the medical cause of death is unknown, imaging can often provide sufficient information with less invasiveness, reduced cost and improved efficiency. PMCT usage in the UK has risen significantly, from 0.2% of post‑mortem investigations in 2015 to 18% by 2024, driven by wider CT availability and pressures on pathology services.
The authors outline how PMCT is performed, noting that scanning techniques mirror clinical CT but with modifications such as whole body protocols and adjusted exposure factors. Enhancements like lung insufflation and post‑mortem angiography can improve diagnostic quality, particularly when investigating coronary artery disease. Techniques such as targeted coronary angiography provide rapid, cost‑effective visualisation of the coronary arteries and can help identify critical stenoses.
Interpreting PMCT requires understanding normal post‑mortem changes. Decomposition, gas formation and tissue density shifts can mimic pathology, complicating interpretation. The brain, for example, rapidly loses grey‑white differentiation, producing appearances that could be mistaken for thrombosis or subarachnoid haemorrhage. Despite these challenges, PMCT can confidently diagnose many causes of death and can often support a probable diagnosis using the ‘balance of probabilities’ standard required in coroner cases. Ultimately, the article highlights PMCT as an increasingly valuable tool that balances diagnostic certainty with practicality, reducing the need for invasive autopsies while ensuring accurate cause‑of‑death assessment.
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