TDM post-mortem sans injection : sémiologie des lésions abdominales post-traumatiques

The purpose of this study was to evaluate a postmortem non-injected CT-scan semiology pointing to a traumatic intra-abdominal viscera lesion in a population of deceased in a road traffic accident. A total of twenty-three corpses had non-injected CT-scan before autopsy. The mean time between the road traffic accident and the CT-scan was of 48 hours. The CT-scan features collected were: the liver, spleen, renal and pancreas heterogeneity, a focal blood effusion in contact of the viscera, extra-vascular and intra-parenchymatous gas and penetrating bone fragment. For this study, the viscera injuries were classified in major and minor lesions. The CT-scans were analyzed jointly by a radiologist and forensic doctor and a rereading was held after the autopsy in a multidisciplinary meeting. Sensitivity and specificity of CT-scan were calculated each by lesion and by organ. Twenty organs were injured which of 13 had major lesions. Twelve lesions were described on the CT-scan analysis. The CT-scan sensitivity and specificity to diagnose intra-abdominal visceral injuries was of respectively 61 % and 98 %. The sensitivity was higher for the major lesions (71 %). The focal blood effusion in contact of a viscera was the best CT-scan feature to diagnose a viscera injury, with a sensitivity of 50 %. It was not improved by the rereading performed after the autopsy. A postmortem CT-scan semiology exists and needs to be described. In case of intra-abdominal viscera injury, our study finds that the lesions are never directly discernible. Nevertheless, the use of 2 simple CT-scan features (focal blood effusion and penetrating bone fragment) helps in the detection of these lesions.