Pleural Fluid Accumulation Detectable on Paediatric Post-mortem Imaging: a Possible Marker of Interval Since Death?

Overview

Journal Int J Legal Med

Specialty Forensic Sciences

Date 2016 Feb 6

PMID 26846767

Citations 7

Authors

J L Barber

J C Hutchinson

N J Sebire

O J Arthurs

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this preliminary study is to evaluate whether pleural fluid accumulates following death in a predictable manner, in particular whether such collections are related to post-mortem interval.

Methods: Images acquired by post-mortem magnetic resonance imaging (PMMR) were both subjectively and objectively assessed for extent of pleural fluid accumulation. Total thoracic volume and pleural fluid volume were calculated using segmentation functions on OSIRIX software. The percentage of pleural fluid as a percentage of thoracic volume was calculated, to account for variation in subject size. The cause of death as per the final autopsy report and the interval from death to imaging were also recorded.

Results: Twelve perinatal deaths/stillbirths (mean gestation 38 weeks, range 24-48 weeks, male/female 5:7) and 11 childhood deaths (mean age 1 year, range 1 day-4 years, male/female 3:8) were assessed. The mean interval from death to imaging for all cases was 7.5 days (range 1-23 days). Pleural fluid was present in almost all cases, and the mean percentage pleural effusion as a proportion of thoracic volume was 3.3 % (range 0.2-9.5 %). There was a significant correlation between the post-mortem interval and the amount of pleural fluid in childhood deaths (p < 0.05) but no significant relationship for perinatal deaths.

Conclusion: The accumulation of pleural fluid detectable on PMMR in children is related to post-mortem interval. If this holds for a larger population, it may therefore be a useful marker for estimating time of death. A similar relationship was not found for perinatal deaths and stillbirths, the reasons for which remain uncertain.

Citing Articles

How to report perinatal and paediatric postmortem CT.

Shelmerdine S, Arthurs O Insights Imaging. 2024; 15(1):129.

PMID: 38816589 PMC: 11139809. DOI: 10.1186/s13244-024-01698-5.

Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy.

OKeefe H, Shenfine R, Brown M, Beyer F, Rankin J BMJ Open. 2023; 13(1):e064774.

PMID: 36609326 PMC: 9827258. DOI: 10.1136/bmjopen-2022-064774.

The Practicality of Post-mortem Imaging in Prenatal, Perinatal, and Pediatric Cases.

Ashby C, Razzak A, Kogler A, Amireh A, Dempsey J, Lin K Cureus. 2022; 14(9):e28859.

PMID: 36225432 PMC: 9536932. DOI: 10.7759/cureus.28859.

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review.

Shelmerdine S, Langan D, Sebire N, Arthurs O BMJ Paediatr Open. 2019; 3(1):e000566.

PMID: 31799452 PMC: 6863669. DOI: 10.1136/bmjpo-2019-000566.

Perinatal post mortem ultrasound (PMUS): a practical approach.

Shelmerdine S, Sebire N, Arthurs O Insights Imaging. 2019; 10(1):35.

PMID: 30887398 PMC: 6423182. DOI: 10.1186/s13244-019-0723-9.

References

Miller K, Stagg C, Douaud G, Jbabdi S, Smith S, Behrens T . Diffusion imaging of whole, post-mortem human brains on a clinical MRI scanner. Neuroimage. 2011; 57(1):167-181. PMC: 3115068. DOI: 10.1016/j.neuroimage.2011.03.070. View

Ishida M, Gonoi W, Hagiwara K, Okuma H, Shintani Y, Abe H . Fluid in the airway of nontraumatic death on postmortem computed tomography: relationship with pleural effusion and postmortem elapsed time. Am J Forensic Med Pathol. 2014; 35(2):113-7. DOI: 10.1097/PAF.0000000000000083. View

Sienko A, Altshuler G . Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines. Obstet Gynecol. 1999; 94(3):415-20. DOI: 10.1016/s0029-7844(99)00307-5. View

Hyodoh H, Shimizu J, Watanabe S, Okazaki S, Mizuo K, Inoue H . Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT). Leg Med (Tokyo). 2015; 17(4):221-5. DOI: 10.1016/j.legalmed.2015.01.002. View

Thayyil S, Sebire N, Chitty L, Wade A, Chong W, Olsen O . Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet. 2013; 382(9888):223-33. DOI: 10.1016/S0140-6736(13)60134-8. View

Smart J, Kaliszan M . The post mortem temperature plateau and its role in the estimation of time of death. A review. Leg Med (Tokyo). 2012; 14(2):55-62. DOI: 10.1016/j.legalmed.2011.11.002. View

Fischer F, Grimm J, Kirchhoff C, Reiser M, Graw M, Kirchhoff S . Postmortem 24-h interval computed tomography findings on intrahepatic gas development and changes of liver parenchyma radiopacity. Forensic Sci Int. 2011; 214(1-3):118-23. DOI: 10.1016/j.forsciint.2011.07.033. View

Sharma S, Singh D, Kaul D . AATF RNome has the potential to define post mortem interval. Forensic Sci Int. 2015; 247:e21-4. DOI: 10.1016/j.forsciint.2014.12.008. View

Kang X, Cos T, Guizani M, Cannie M, Segers V, Jani J . Parental acceptance of minimally invasive fetal and neonatal autopsy compared with conventional autopsy. Prenat Diagn. 2014; 34(11):1106-10. DOI: 10.1002/pd.4435. View

10.

Vass A . The elusive universal post-mortem interval formula. Forensic Sci Int. 2010; 204(1-3):34-40. DOI: 10.1016/j.forsciint.2010.04.052. View

11.

Lendoiro E, Cordeiro C, Rodriguez-Calvo M, Vieira D, Suarez-Penaranda J, Lopez-Rivadulla M . Applications of Tandem Mass Spectrometry (LC-MSMS) in estimating the post-mortem interval using the biochemistry of the vitreous humour. Forensic Sci Int. 2012; 223(1-3):160-4. DOI: 10.1016/j.forsciint.2012.08.022. View

12.

Shiotani S, Kobayashi T, Hayakawa H, Kikuchi K, Kohno M . Postmortem pulmonary edema: a comparison between immediate and delayed postmortem computed tomography. Leg Med (Tokyo). 2011; 13(3):151-5. DOI: 10.1016/j.legalmed.2010.12.008. View

13.

Cherix D, Wyss C, Pape T . Occurrences of flesh flies (Diptera: Sarcophagidae) on human cadavers in Switzerland, and their importance as forensic indicators. Forensic Sci Int. 2012; 220(1-3):158-63. DOI: 10.1016/j.forsciint.2012.02.016. View

14.

Anders S, Kunz M, Gehl A, Sehner S, Raupach T, Beck-Bornholdt H . Estimation of the time since death--reconsidering the re-establishment of rigor mortis. Int J Legal Med. 2011; 127(1):127-30. DOI: 10.1007/s00414-011-0632-z. View

15.

Arthurs O, Price G, Carmichael D, Jones R, Norman W, Taylor A . Diffusion-weighted perinatal postmortem magnetic resonance imaging as a marker of postmortem interval. Eur Radiol. 2014; 25(5):1399-406. PMC: 4392167. DOI: 10.1007/s00330-014-3525-y. View

16.

Scheurer E, Ith M, Dietrich D, Kreis R, Husler J, Dirnhofer R . Statistical evaluation of time-dependent metabolite concentrations: estimation of post-mortem intervals based on in situ 1H-MRS of the brain. NMR Biomed. 2004; 18(3):163-72. DOI: 10.1002/nbm.934. View

17.

Donaldson A, Lamont I . Biochemistry changes that occur after death: potential markers for determining post-mortem interval. PLoS One. 2013; 8(11):e82011. PMC: 3836773. DOI: 10.1371/journal.pone.0082011. View