Citation

Laurent PE, Coulange M, Mancini J, Bartoli C, Desfeux J, Perich P, Piercecchi-Marti MD, Vidal V, Bartoli JM, Léonetti G, Gorincour G. J. Forensic Radiol. Imaging 2013; 1(2): 84.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.jofri.2013.03.015

PMID

unavailable

Abstract

Objectives
To define the computed tomography (CT) semiology of post-mortem gas collections linked to putrefaction, post-mortem "off-gassing" and decompression illness (DI) after fatal diving accidents and to establish CT diagnostic criteria for different causes of death in diving.
Materials and methods
A 4-year prospective study was conducted including cases of death diving referred to our center. For each subject a hyperbaric physician analyzed the circumstances of death and interviewed rescue crews and witnesses. A post-mortem full body CT scan was conducted followed by an autopsy. The following criteria were examined: intra-arterial gas, intravenous gas, complete pneumatization of supra-aortic trunks, complete pneumatization of the right ventricle, presence of subcutaneous emphysema limited to the thoracic area, and presence of a pneumothorax.
Results
Eighteen subjects were included in the study. The presence of intra-arterial gas associated with death by DI had a negative predictive value (NPV) of 100% but the positive predictive value (PPV) was only 54% because of post-mortem off-gassing. The PPV reached 70% when considering pneumatization of the supra-aortic trunks. Pneumothorax had a poor PPV (53%) for DI. Putrefaction gas is not visible in the arteries for the first 24 h after death.
Conclusion
Pneumothorax, subcutaneous emphysema, and/or intra-arterial gas, all of which are classical criteria for DI diagnosis, are not specific to a DI. Complete pneumatization of supra-aortic trunks and of the right ventricle are the best CT criteria to detect a fatal DI when the scanner is conducted within 24 h after death.