PMID- 25687811 OWN - NLM STAT- MEDLINE DCOM- 20160106 LR - 20161125 IS - 1872-6283 (Electronic) IS - 0379-0738 (Linking) VI - 249 DP - 2015 Apr TI - Can ruptured abdominal aortic aneurysm be accurately diagnosed as the cause of death without postmortem computed tomography when autopsies cannot be performed? PG - 107-11 LID - S0379-0738(15)00036-5 [pii] LID - 10.1016/j.forsciint.2015.01.022 [doi] AB - PURPOSE: This study aimed to conduct a multicentre retrospective review of cases to clarify how many ruptured abdominal aortic aneurysms (RAAAs) as the cause of death could be diagnosed without post-mortem computed tomography (PMCT) when autopsies cannot be performed. METHODS: We collected consecutive PMCT data from January 2002 to December 2009 from three institutes where PMCT examinations are performed on a routine basis for deceased patients with unknown causes of death. A total of 19 cases were identified where PMCT revealed RAAAs. Ante-mortem clinical presentations, post-mortem external examinations, and peri-mortem ultrasonography findings were assessed for their diagnostic accuracy. RESULTS: The correct diagnosis based on the classic triad of shock, acute abdominal pain, and pulsatile abdominal mass was made in only one of 19 (5.3%) patients. Shock, acute abdominal pain, and abdominal swelling were found in five of 19 (26%) patients. Shock and acute abdominal pain or abdominal swelling were found in two of 19 (10%) patients. Ten of 19 (53%) patients only had shock. Peri-mortem ultrasonography was performed in seven of 19 patients; one was diagnosed with RAAA (14%). No patients had pre-mortem CT examinations. CONCLUSIONS: Post-mortem diagnosis of RAAA is difficult to make based on ante-mortem clinical presentation, post-mortem external examinations, or peri-mortem ultrasonography. PMCT is recommended for diagnosing RAAA as the cause of death if pre-mortem CT examinations are not carried out when autopsies cannot be performed. CI - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Makino, Yohsuke AU - Makino Y AD - Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: ymakino-tky@umin.ac.jp. FAU - Yamamoto, Seiji AU - Yamamoto S AD - Autopsy Imaging Information Center, 4-6-10 Ginza, Chuo-ku, Tokyo 104-0061, Japan. Electronic address: seikichi@autopsyimaging.com. FAU - Shiotani, Seiji AU - Shiotani S AD - Department of Radiology, Tsukuba Medical Center, 1-3-1 Amakubo, Tsukuba 305-8558, Japan. Electronic address: shiotani@tmch.or.jp. FAU - Hayakawa, Hideyuki AU - Hayakawa H AD - Department of Forensic Medicine, Tsukuba Medical Examiner's Office, 1-3-1 Amakubo, Tsukuba 305-8558, Japan. Electronic address: hayakawa@tmch.or.jp. FAU - Fujimoto, Hajime AU - Fujimoto H AD - Department of Radiology, Numazu City Hospital, 550 Harunoki-aza, Higashishiiji, Numazu, Shizuoka 410-0302, Japan. Electronic address: hfujimot@lilac.ocn.ne.jp. FAU - Yokota, Hajime AU - Yokota H AD - Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan. Electronic address: rd8h-ykt@radio.ne.jp. FAU - Horikoshi, Takuro AU - Horikoshi T AD - Department of Diagnostic Radiology and Radiation Oncology, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: taku_steelfish@yahoo.co.jp. FAU - Iwase, Hirotaro AU - Iwase H AD - Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: iwase@faculty.chiba-u.jp. FAU - Uno, Takashi AU - Uno T AD - Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Diagnostic Radiology and Radiation Oncology, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Electronic address: unotakas@faculty.chiba-u.jp. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20150131 PL - Ireland TA - Forensic Sci Int JT - Forensic science international JID - 7902034 SB - IM MH - Aged MH - Aged, 80 and over MH - Aortic Aneurysm, Abdominal/*diagnostic imaging MH - Aortic Rupture/*diagnostic imaging MH - Autopsy MH - *Cause of Death MH - Female MH - Forensic Pathology/methods MH - Humans MH - Male MH - Middle Aged MH - Reproducibility of Results MH - Retrospective Studies MH - Tomography, X-Ray Computed/*methods OTO - NOTNLM OT - Abdominal aortic aneurysm OT - Autopsy OT - Cause of death OT - Multidetector computed tomography OT - Ruptured aortic aneurysm EDAT- 2015/02/18 06:00 MHDA- 2016/01/07 06:00 CRDT- 2015/02/18 06:00 PHST- 2014/11/09 00:00 [received] PHST- 2015/01/13 00:00 [revised] PHST- 2015/01/23 00:00 [accepted] PHST- 2015/02/18 06:00 [entrez] PHST- 2015/02/18 06:00 [pubmed] PHST- 2016/01/07 06:00 [medline] AID - S0379-0738(15)00036-5 [pii] AID - 10.1016/j.forsciint.2015.01.022 [doi] PST - ppublish SO - Forensic Sci Int. 2015 Apr;249:107-11. doi: 10.1016/j.forsciint.2015.01.022. Epub 2015 Jan 31.