Can ruptured abdominal aortic aneurysm be accurately diagnosed as the cause of death without postmortem computed tomography when autopsies cannot be performed?

• Ruptured abdominal aortic aneurysms (RAAA) can be missed without post-mortem CT.
• Post-mortem external examinations have limited detectability of RAAA.
• Peri-mortem US is not useful for detecting RAAA as a cause of death.
• Pre-mortem CT is not always performed for patients who died of RAAA.
• Post-mortem CT is recommended to be used for diagnose RAAA.

PurposeThis study aimed to conduct a multicentre retrospective review of cases to clarify how many ruptured abdominal aortic aneurysms (RAAAs) as the cause of death could be diagnosed without post-mortem computed tomography (PMCT) when autopsies cannot be performed.MethodsWe collected consecutive PMCT data from January 2002 to December 2009 from three institutes where PMCT examinations are performed on a routine basis for deceased patients with unknown causes of death. A total of 19 cases were identified where PMCT revealed RAAAs. Ante-mortem clinical presentations, post-mortem external examinations, and peri-mortem ultrasonography findings were assessed for their diagnostic accuracy.ResultsThe correct diagnosis based on the classic triad of shock, acute abdominal pain, and pulsatile abdominal mass was made in only one of 19 (5.3%) patients. Shock, acute abdominal pain, and abdominal swelling were found in five of 19 (26%) patients. Shock and acute abdominal pain or abdominal swelling were found in two of 19 (10%) patients. Ten of 19 (53%) patients only had shock. Peri-mortem ultrasonography was performed in seven of 19 patients; one was diagnosed with RAAA (14%). No patients had pre-mortem CT examinations.ConclusionsPost-mortem diagnosis of RAAA is difficult to make based on ante-mortem clinical presentation, post-mortem external examinations, or peri-mortem ultrasonography. PMCT is recommended for diagnosing RAAA as the cause of death if pre-mortem CT examinations are not carried out when autopsies cannot be performed.