Interpretation of intravascular gas on postmortem CT in children

•IV gas was identified on PMCT in most children (63%).•IV gas on PMCT may relate more to resuscitation and IO needles, rather than postmortem interval.•We need a better understanding of IV gas on PMCT in children.

IntroductionThe use of post-mortem computed tomography (PMCT) is increasing, but the significance of some findings, such as intravascular gas, remain uncertain. In order to correctly interpret the findings, we provide data on a series of cases in whom intravascular gas was noted on PMCT imaging, to assess whether it correlates with clinical features including type of death (traumatic), resuscitation and postmortem interval.MethodsChildren <16 years of age who underwent whole-body PMCT as part of their autopsy examination were assessed for the presence and extent of intravascular gas. Demographic details recorded included age, time from death to imaging, associated imaging findings, mode of death, and resuscitation received. Imaging was reviewed by two radiologists, blinded to clinical history and autopsy findings.Results46 children, mean age 2 years (range 0 days–15.5 years) were included in the study. 63% (29/46) children demonstrated IV gas postmortem. No relationship was demonstrated between IV gas at PMCT and increasing postmortem interval or traumatic death. IV gas was seen more commonly following resuscitation attempts including intra-osseous needle insertions, although this did not reach statistical significance.ConclusionIV gas is commonly identified on PMCT in children, and may be related to resuscitation rather than putrefaction or decomposition. A better understanding of IV gas on PMCT will help interpret these findings on future studies.