@article{ref1,
title="CT appearance of gas collections can predict the cause of death in scuba diving accidents",
journal="Journal of forensic radiology and imaging",
year="2013",
author="Laurent, Pierre-Eloi and Coulange, Mathieu and Mancini, Julien and Bartoli, Christophe and Desfeux, Jacques and Perich, Pierre and Piercecchi-Marti, Marie-Dominique and Vidal, Vincent and Bartoli, Jean-Michel and Léonetti, Georges and Gorincour, Guillaume",
volume="1",
number="2",
pages="84-84",
abstract="Objectives  To define the computed tomography (CT) semiology of post-mortem gas collections linked to putrefaction, post-mortem &quot;off-gassing&quot; 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.<p />",
language="",
issn="2212-4780",
doi="10.1016/j.jofri.2013.03.015",
url="http://dx.doi.org/10.1016/j.jofri.2013.03.015"
}