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Fluid in the Airway of Nontraumatic Death on Postmortem Computed Tomography: Relationship With Pleural Effusion and Postmortem Elapsed Time

Ishida, Masanori MD, PhD*†; Gonoi, Wataru MD, PhD*; Hagiwara, Kazuchika MD, PhD*; Okuma, Hidemi MD*; Shintani, Yukako MD, PhD; Abe, Hiroyuki MD, PhD; Takazawa, Yutaka MD, PhD; Ohtomo, Kuni MD, PhD*; Fukayama, Masashi MD, PhD

American Journal of Forensic Medicine & Pathology: June 2014 - Volume 35 - Issue 2 - p 113–117
doi: 10.1097/PAF.0000000000000083
Original Articles

Abstract: To evaluate radiographic features of endotracheal/endobronchial fluid in the airway (FA) observed on postmortem computed tomography (PMCT). We studied 164 subjects who died at our hospital between April 2009 and September 2012. Fluid in the airway was considered positive when fluid was identified in the lumen of 1 of the 2 main bronchi in continuity with a segmental bronchus. Pleural effusion and atelectasis/consolidation of the lung lower lobes were also evaluated. Fluid in the airway was observed in 60 (71%) of 84 subjects with unilateral or bilateral pleural effusion, and in 44 (55%) of 80 subjects without pleural effusion (P = 0.029). Of the latter, 41 (93%) had atelectasis/consolidation of the lower lung lobes. Among subjects without pleural effusion, average times after death to PMCT of subjects with and without FA were 501 and 314 minutes, respectively (P = 0.01). Time-course analysis showed that cases with FA on PMCT largely correlated with time after death (R2 = 0.7966). Fluid in the airway is frequently observed on PMCT in subjects with pleural effusion or atelectasis/consolidation of the lung. No FA in subjects without pleural effusion correlated to shorter times after death. In addition, FA frequency on PMCT increased over time after death.

*Department of Radiology, Graduate School of Medicine, The University of Tokyo; †Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital; and ‡Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Manuscript received August 10, 2013; accepted December 1, 2013.

The authors report no conflicts of interest.

Reprints: Masanori Ishida, MD, PhD, Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan. E-mail: masanoriishida@hotmail.com.

This work was supported in part by a grant from the Japanese Ministry of Health, Labor and Welfare for research into “Usefulness of Postmortem Images as an Ancillary Method for Autopsy in Evaluation of Death Associated With Medical Practice (2008–2009).”

© 2014 by Lippincott Williams & Wilkins.