Postmortem Computed Tomography Findings Associated with Sudden Death in Alcoholics.

Abstract

Forensic pathologists.frequently encounter sudden natural.death of alcoholic in which fatty liver is the only pathological finding detected at autopsy, however, characteristics of postmortem CT (PMCT) of sudden death of alcoholic have not been reported so far. In this study, we investigated radiographic measurements of PMCT of the cases diagnosed as sudden death of alcoholic (ALC), and compared them with those of other causes of death (IHD; ischemic heart disease, SV; starvation), with reference to autopsy findings. The cardio-thoracic ratio, the cross-sectional area of the inferior vena cava and the radio density of the lungs of ALC on PMCT were significantly lower than those of IHD, and tended to be midway between IHD and SV. These findings were in parallel with the total heart blood volume at autopsy and the extent of lung edema on histopathological findings. In addition, the radiodensity of the liver of ALC was significantly lower than the other groups, which was in parallel with the extent of fatty deposit in the hepatocytes on histopathology. More than 60% of ALC cases showed BMI < 18.0, and acetone was detected in blood in 87.5% of ALC cases. The lower radiodensity of the liver, and lack of signs suggestive of significant pulmonary edema and congestion in the great vessels, on PMCT, are considered to mirror terminal pathophysiology of sudden death of alcoholic, such as severe fatty liver- disease and metabolic disturbance (e.g., concomitant volume depletion with alcoholic ketoacidosis). Utilization of these findings on PMCT may serve to discern sudden death of alcoholic from other causes of death, in combination with detailed scene investigation, pathological, toxicological and biochemical analysis.