15283-B-Blokker

145 CT and MR features of postmortem change in deaths 8 Resuscitation can cause rib fractures, pneumothorax, lung contusions, hemothorax, and intravascular air. We found that the majority of PRS patients showed significantly more intravascular air as opposed to non-PRS patients, suggesting that air was introduced during resuscitation. 210,222,243,244 Intravascular air after resuscitation is caused by pneumatization of dissolved gas in the blood as a result of compression and expansion of vessels and direct mechanical force to the chest allowing air from the lungs to enter the bloodstream. 245,246 Likewise resuscitation attempts may introduce free abdominal air that should not be confused with free air caused by intestinal perforation. 211 Pleural effusion, periportal edema, and distended intestines were also more frequently observed after resuscitation. Postmortem clotting occurred less often in PRS patients and we hypothesize this is caused by anti-coagulation given during resuscitation attempts. 210,222,243,244 Lack of oxygenation in the brain was noted by loss of grey- white matter differentiation, edema, swelling of the brain and effacement of sulci. 218,247,248 These features involve the entire brain and are symmetrical. 116,218 Patients with elevated intracranial pressure prior to death may show similar features, and comparison to antemortem scans is recommended. In living patients a dense-artery-sign in the cerebral arteries is often asymmetric and indicative for cerebral ischemia, a postmortem mimic of this sign is usually symmetrical and is non-pathological (Fig 1A). The cessation of cardiac output and fall in blood pressure causes the arterial wall to collapse directly after death. 225,249 This change may obscure an aortic aneurysm or dissection. Within 2 hours after death blood clots form in the heart and large vessels. Postmortem clots are best detected on PMMR; the clot shows low T2 signal relative to the high T2 signal of the serum. A postmortem clot can often be distinguished from a central pulmonary embolism that shows a more homogeneous high T1 signal (Fig 6A-J). Other distinctive features of postmortem clots are that they are seen in the dependent areas of the vessel, usually fill only part of the lumen and do not expand the lumen. With pulmonary embolism the thrombus follows the blood stream until it reaches a point where the lumen becomes too narrow or the vessel branches. The shape of a postmortem clot is often more irregular than a thrombus (Fig 6C-D). 250 If clinically relevant, a CT-guided biopsy may help differentiate between postmortem clotting and pulmonary embolism. In this study we investigated in-hospital deceased adult deaths. The mean PTI was relatively short and bodies were stored in a protected environment after death, PTI seem to have an impact on the occurrence and extent of specific changes.