Jackowski Christian, Sonnenschein Martin, Thali Michael J, Aghayev Emin, Yen Kathrin, Dirnhofer Richard, Vock Peter
Institute of Forensic Medicine, University of Bern, Switzerland.
J Trauma. 2007 Apr;62(4):979-88. doi: 10.1097/01.ta.0000198733.22654.de.
Until August 2004 there were 106 forensic cases examined with postmortem multislice computed tomography (MSCT) and magnetic resonance (MR) imaging before traditional autopsy within the Virtopsy project. Intrahepatic gas (IHG) was a frequent finding in postmortem MSCT examinations. The aim of this study was to investigate its cause and significance.
There were 84 virtopsy cases retrospectively investigated concerning the occurrence, location, and volume of IHG in postmortem MSCT imaging (1.25 mm collimation, 1.25 mm thickness). We assessed and noted the occurrence of intestinal distention, putrefaction, and systemic gas embolisms and the cause of death, possible open trauma, possible artificial respiration, and the postmortem interval. We investigated the relations between the findings using the contingency table (chi2 test) and the comparison of the postmortem intervals in both groups was performed using the t test in 79 nonputrefied corpses.
IHG was found in 47 cases (59.5%). In five of the cases, the IHG was caused or influenced by putrefaction. Gas distribution within the liver of the remaining 42 cases was as follows: hepatic arteries in 21 cases, hepatic veins in 35 cases, and portal vein branches in 13 cases; among which combinations also occurred in 20 cases. The presence of IHG was strongly related to open trauma with systemic gas. Pulmonary barotrauma as occurring under artificial respiration or in drowning also caused IHG. Putrefaction did not seem to influence the occurrence of IHG until macroscopic signs of putrefaction were noticeable.
IHG is a frequent finding in traumatic causes of death and requires a systemic gas embolism. Exceptions are putrefied or burned corpses. Common clinical causes such as necrotic bowel diseases appear rarely as a cause of IHG in our forensic case material.
在虚拟尸检项目中,截至2004年8月,有106例法医案件在传统尸检前接受了尸检多层螺旋计算机断层扫描(MSCT)和磁共振(MR)成像检查。肝内气体(IHG)是尸检MSCT检查中常见的发现。本研究的目的是调查其原因和意义。
回顾性研究了84例虚拟尸检病例,观察尸检MSCT成像(准直1.25mm,层厚1.25mm)中IHG的发生情况、位置和体积。我们评估并记录了肠扩张、腐败和全身性气体栓塞的发生情况以及死因、可能的开放性创伤、可能的人工呼吸和死后间隔时间。我们使用列联表(卡方检验)研究这些发现之间的关系,并对79例未腐败尸体使用t检验比较两组的死后间隔时间。
47例(59.5%)发现有IHG。其中5例中,IHG是由腐败引起或受其影响。其余42例肝脏内气体分布如下:肝动脉21例,肝静脉35例,门静脉分支13例;其中20例还存在多种组合情况。IHG的存在与伴有全身性气体的开放性创伤密切相关。人工呼吸或溺水时发生的肺气压伤也会导致IHG。在出现明显的腐败宏观征象之前,腐败似乎并未影响IHG的发生。
IHG在创伤性死亡原因中很常见,且需要全身性气体栓塞。腐败或烧焦的尸体除外。在我们的法医病例材料中,坏死性肠道疾病等常见临床病因很少作为IHG的病因出现。