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Postmortem Imaging: MDCT Features of Postmortem Change and Decomposition

Levy, Angela D. MD*; Harcke, Howard Theodore MD*†; Mallak, Craig T. MD

The American Journal of Forensic Medicine and Pathology: March 2010 - Volume 31 - Issue 1 - p 12-17
doi: 10.1097/PAF.0b013e3181c65e1a

Multidetector computed tomography (MDCT) has emerged as an effective imaging technique to augment forensic autopsy. Postmortem change and decomposition are always present at autopsy and on postmortem MDCT because they begin to occur immediately upon death. Consequently, postmortem change and decomposition on postmortem MDCT should be recognized and not mistaken for a pathologic process or injury. Livor mortis increases the attenuation of vasculature and dependent tissues on MDCT. It may also produce a hematocrit effect with fluid levels in the large caliber blood vessels and cardiac chambers from dependent layering erythrocytes. Rigor mortis and algor mortis have no specific MDCT features. In contrast, decomposition through autolysis, putrefaction, and insect and animal predation produce dramatic alterations in the appearance of the body on MDCT. Autolysis alters the attenuation of organs. The most dramatic autolytic changes on MDCT are seen in the brain where cerebral sulci and ventricles are effaced and gray-white matter differentiation is lost almost immediately after death. Putrefaction produces a pattern of gas that begins with intravascular gas and proceeds to gaseous distension of all anatomic spaces, organs, and soft tissues. Knowledge of the spectrum of postmortem change and decomposition is an important component of postmortem MDCT interpretation.

From the *Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md; †Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC; and ‡The Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Rockville, Md.

The opinions and assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting the view of the Department of the Army, Navy, or Defense.

Figures can be viewed in color at

Reprints: Angela D. Levy, MD, Department of Radiology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.