Non-specific post-mortem modifications on whole-body post-mortem computed tomography in sudden unexpected death in infancy

• Clinical paediatric radiologists should be aware of non-specific post-mortem signs.
• Some non-specific post-mortem modifications in children are the same as in adults.
• Whole-body PMCT has paediatric specificities.

ObjectivesTo provide an overview of non-specific modifications on whole-body post-mortem computed tomography (PMCT) images of infants and children.Materials and methods69 infants and children underwent a whole-body PMCT scan at our institution following sudden unexpected death. Two paediatric radiologists reviewed the PMCT images, specifically focusing on non-specific postmortem modifications unrelated to the presumed cause of death.ResultsIatrogenic post-mortem modifications included focal infiltration of the legs (n=15) and hemopericardium (n=2). Vascular postmortem modifications included hypostasis (density in the posterior sagittal sinus was correlated with density in the dependent portion of the heart (p<0.001)), portal vein thrombosis (n=56, 75.3%), hyperattenuating aortic wall and reduced abdominal aortic diameter (n=69, 100%). Intravascular gas was detected in 40 subjects (57.9%). Ligamentum arteriosum calcification was seen in 42 children and was not correlated with age (p=0.68). Umbilical artery calcification was found in 30 children and was correlated with age (p<0.005). Gaseous distension of the stomach (n=45, 65.2%) and bowels (n=44, 63.7%) was a frequent finding. Mean liver density was 49.6±7.5 HU and mean spleen density was 43.2±5.9 HU. Ground-glass opacity was observed in 63 cases (91.3%) and mild bilateral consolidation in 16 cases (23.1%).ConclusionNon-specific post-mortem signs are rare and new to clinical paediatric radiologists. They should be aware of these signs when interpreting whole-body PMCT images in cases of sudden unexpected death in infancy or childhood in order to avoid pitfalls that may have a critical impact.