Postmortem Computed Tomography and Difficult Autopsies

Grace Wong, Yi-Li (2025) Postmortem Computed Tomography and Difficult Autopsies. In: The International Congress of Pathology & Laboratory Medicine (ICPALM) 2025: Pathology & Artificial Intelligence: Transforming Diagnostic & Patient Care, 21st-23rd July 2025, Shangri-La Hotel, Kuala Lumpur, Malaysia.

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Abstract

PMCT serves as a useful adjunct to difficult autopsies, particularly in the evaluation of bone and gas distributions. Deaths resulting from suspected paediatric, adult or elderly abuse; deaths in custody, community centres or nursing homes require comprehensive multidisciplinary investigations and medicolegal documentation. Older neglected or healed bone fractures with callus formations may not always have external findings and can be missed without imaging. Additionally, PMCT can screen anatomical areas that are not routinely dissected, such as the spine and extremities, guiding targeted dissections or limited autopsies at regions of interest. For mass deaths, disasters, pandemics, blast or thermal related deaths, PMCT provides a quick means to triage cases, evaluate the extent of bone trauma/fragmentation and identify foreign bodies. Be aware that many PMCT findings can be equivocal and non-specific such as in the assessments of lung opacities, patterns of air distributions and fluid accumulations. PMCT findings of decomposition changes and resuscitation efforts often overlap with antemortem natural disease processes, iatrogenic injury, drowning and barotrauma e.g. diving, especially if the PMCT cannot be done soon after death, taking into consideration internal body and external environmental factors that may affect decomposition rate. The role of PMCT in identification for advanced decomposition, skeletonization, mummification and incomplete remain still requires large population-based research with comparisons to anthropological findings. For difficult autopsy cases, the combination of scene of death findings, postmortem imaging, autopsy, histopathologic and laboratory analysis are essential to extrapolate cause and manner of deaths more accurately.

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