Application of compact ultrasound imaging device to postmortem diagnosis

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Abstract

In regions with low autopsy rates, forensic examiners often have to rely on external findings. Imaging techniques can assist the external examination and provide a more objective diagnosis. The SonoSite™180, a portable ultrasound device, was used for the examination of dead bodies. The influence of different degrees of decomposition was estimated. Even in cases with intestinal gas formation images of internal organs could be obtained with special techniques. Various pathological findings were detected by ultrasound and verified by autopsy (e.g. pericardial tamponade, cardiac hypertrophy, fatty liver, aortic aneurysm, metastatic liver, etc.). The experiences with the SonoSite™180 are promising. The device can be carried to the death scene or to the morgue and therefore serve as a valuable tool for medicolegal applications.

Introduction

People all over the world, but especially in eastern Asia and in the middle east, have a regrettable tendency to refuse autopsies for a variety of reasons. Medical examiners must “diagnose” the cause of death based on the death scene, medical anamnesis of the deceased (if available), and on whatever can be found on the body surface. In developed countries with well equipped medical institutions imaging techniques, for example X-ray, CT scanner and MRI, are sometimes “expensive” auxiliary tools for the investigation of dead bodies. The misleading term “virtual autopsy” (Virtopsy) was created.

In this paper, we describe the possibility of applying ultrasound imaging to postmortem investigations.

Section snippets

Estimation of the degree of decomposition suitable for ultrasound imaging

Corpses in different stages of decomposition were examined by an ultrasound imaging device (SonoSite™180, SonoSite Inc., SE Bothell, WA, USA) with 2–5 MHz abdominal probe in Tokyo Medical Examiner’s Office, Nihon University School of Medicine and in the Institute of Legal Medicine, University Hospital Hamburg-Eppendorf. The investigations were carried out at different time points: just after admission to each institute or after 1 day storage in the refrigerator (4 °C) in Japan and after 1–3 days

Results

One hundred and fifty eight cases have been examined with SonoSite™180. Table 1 shows the pathomorphological cause of death of the cases. Forensically relevant findings (Table 2) were detected in about 25% of all investigated cadavers.

Discussion

In clinical practice, sonography is one of the most common diagnostic imaging procedures. It is easy to use and causes the patient no harm. In addition, there is not even the worry of contamination by radiation. One of the major disadvantages of ultrasound is its disability to pass through air. To our knowledge, Akopov et al. [1] were the first to underline the significance of ultrasound imaging as a supportive technique in medicolegal investigations. In this article attending patients,

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