Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.
Department of Forensic Medicine, Monash University, Clayton, Australia.
Forensic Sci Med Pathol. 2021 Dec;17(4):611-620. doi: 10.1007/s12024-021-00389-7. Epub 2021 Jun 23.
CoVID-19 is a novel viral infection with now well-established clinical radiological findings. There is limited data on post-mortem imaging. We explore the proposition that PMCT could be used as screening test. In an 11-week period, 39 deceased persons were referred for medicolegal investigation with pre-existing or subsequent nasopharyngeal swabs showing positivity on SARS-CoV-2 RT-PCR testing. All 39 had routine whole-body CT scans on admission and 12 underwent medicolegal autopsy. These cases were contrasted with 4 others which were negative on nasopharyngeal swabs despite PMCT findings suggestive of CoVID-19 pneumonia (designated false positive). Nine of the 12 autopsies showed lung histology consistent with those reported in CoVID-19 pneumonia. Typical clinical CoVID-19 lung findings on PMCT were only detected in 5 (42%). In 3 of the 4 false positive cases, lung findings showed non-COVID-19 histology but in 1, findings were identical. PMCT CoVID-19 findings in the lungs are therefore not specific and may not be detected in all cases due to obscuration by expected agonal CT findings or other pathologies that pre-dated SARS-CoV-2 infection. PMCT findings may otherwise be subtle. Although PMCT may hint at CoVID-19, we believe that nasopharyngeal swabs are still required for definitive diagnosis. Even with positive swabs, clinical CoVID-19 lung findings on PMCT are often not detected. PMCT findings can be subtle, extreme or obscured by agonal changes. Given this range of PMCT changes, the challenge for pathologists is to determine whether death has been caused by, or merely associated with, SARS-CoV-2 infection.
COVID-19 是一种新型病毒感染，现已确立了明确的临床放射学表现。关于死后影像学的资料有限。我们探讨了 PMCT 可作为筛查试验的可能性。在 11 周的时间里，有 39 名死者因法医学调查而被转介，他们生前或随后的鼻咽拭子在 SARS-CoV-2 RT-PCR 检测中呈阳性。所有 39 例入院时均进行了常规全身 CT 扫描，12 例行法医学尸检。将这些病例与另外 4 例 PMCT 结果提示 COVID-19 肺炎（指定为假阳性）但鼻咽拭子为阴性的病例进行对比。12 例尸检中有 9 例显示肺组织学与 COVID-19 肺炎报告一致。仅在 5 例（42%）中检测到典型的 COVID-19 肺炎的 PMCT 临床表现。在 4 例假阳性病例中，3 例的肺部表现显示为非 COVID-19 组织学，但 1 例相同。因此，PMCT 对 COVID-19 的发现并不具有特异性，并且由于预期的濒死 CT 表现或 SARS-CoV-2 感染前的其他病理改变而可能无法在所有病例中检测到。PMCT 的表现可能不明显。尽管 PMCT 可能提示 COVID-19，但我们认为仍需要鼻咽拭子进行明确诊断。即使鼻咽拭子阳性，PMCT 上也常常无法检测到 COVID-19 的肺部表现。PMCT 的表现可能不明显、极端或被濒死变化所掩盖。鉴于 PMCT 变化的范围，病理学家面临的挑战是确定死亡是由 SARS-CoV-2 感染引起的，还是仅仅与 SARS-CoV-2 感染相关。
