Combining virtual endoscopy and postmortem computed tomography to identify airway obstruction by a peritonsillar abscess as the cause of an asphyxia death

Abstract

Peritonsillar abscess (PTA) is the most common deep neck infection, with well-known complications such as airway stenosis and aspiration pneumonia. However, death due to asphyxia caused by PTA is extremely rare in forensic research reports. Traditionally, the autopsy is the standard diagnostic method for pharyngeal lesions in forensic practice. The incorporation of postmortem computed tomography (PMCT) into the medicolegal death investigation has demonstrated unique diagnostic advantages for specific findings. In addition, virtual endoscopy (VE) shows great potential for supporting hollow organ assessment and postmortem diagnosis. Here, we report a case of asphyxial death due to airway obstruction caused by PTA. While autopsy, histopathological examination, and bacterial culture of fluid collected from the abscess effectively diagnosed PTA as the cause of airway obstruction leading to death, this case illustrates that PMCT combined with VE can be a valuable adjunct for in situ diagnosis.