Michiue Tomomi, Ishikawa Takaki, Sakoda Shigeki, Quan Li, Li Dong-Ri, Kamikodai Yasunobu, Okazaki Shuji, Zhu Bao-Li, Maeda Hitoshi
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
Leg Med (Tokyo). 2010 Mar;12(2):73-8. doi: 10.1016/j.legalmed.2009.11.007. Epub 2010 Jan 29.
It is difficult to examine the intact in situ status of thoracic organs, including the heart and lungs, after opening the chest at autopsy. The present study investigated the pathological diagnostic significance of the cardiothoracic ratio (CTR) with regard to heart and lung weight in postmortem plain chest radiography. The pathological diagnostic significance of the CTR in postmortem plain chest radiography using serial forensic autopsy cases of adults (>19 years of age, n=367, within 72 h postmortem) was retrospectively investigated. In natural deaths, CTR was larger for heart diseases, and was smaller for pulmonary infection and gastrointestinal bleeding, showing correlations to the heart weight except in cases of hemopericardium. In traumatic deaths, CTR was larger in cases of fire fatality and acute methamphetamine intoxication, and varied in cases of blunt injury, showing correlations to the heart weight. However, CTR was smaller for sharp instrument injury and drowning, independently of the heart weight. These findings suggest that postmortem CTR (median, 55.6%, measured using a mobile X-ray apparatus) primarily depends on the heart weight, but is substantially modified during the process of death: the CTR may be enlarged by cardiac dilatation due to terminal congestive heart failure, but may be reduced by inflated lungs in drowning or hypovolemia due to fatal hemorrhage. CTR showed a mild correlation to the right diaphragm level, which was also related to the cause of death, but was independent of the left diaphragm level. Plain chest radiographic findings may also be helpful in investigating the pathophysiology of death, and are to some extent comparable with clinical findings. This also suggests the potential usefulness of postmortem CT and MRI for analysis of terminal cardiac function.
在尸检时打开胸腔后，很难检查包括心脏和肺在内的胸部器官的完整原位状态。本研究调查了在死后胸部平片检查中心胸比率（CTR）对于心脏和肺重量的病理诊断意义。回顾性研究了使用成人（>19岁，n = 367，死后72小时内）系列法医尸检病例进行死后胸部平片检查时CTR的病理诊断意义。在自然死亡中，心脏病患者的CTR较大，肺部感染和胃肠道出血患者的CTR较小，除心包积血病例外，CTR与心脏重量相关。在创伤性死亡中，火灾致死和急性甲基苯丙胺中毒病例的CTR较大，钝器伤病例的CTR有所不同，且与心脏重量相关。然而，锐器伤和溺水病例的CTR较小，与心脏重量无关。这些发现表明，死后CTR（中位数为55.6%，使用移动X射线设备测量）主要取决于心脏重量，但在死亡过程中会有显著改变：由于终末期充血性心力衰竭导致心脏扩张，CTR可能会增大，但溺水或因致命性出血导致血容量不足时，肺部膨胀可能会使CTR减小。CTR与右膈水平呈轻度相关，右膈水平也与死因有关，但与左膈水平无关。胸部平片检查结果也可能有助于研究死亡的病理生理学，并且在一定程度上与临床检查结果具有可比性。这也表明死后CT和MRI在分析终末期心脏功能方面具有潜在的应用价值。
