Postmortem Imaging in Sudden Adult Death

Abstract

Several definitions of “sudden and unexpected death” exist. The World Health Organization definition is of natural death within 24 h from the onset of symptoms, but this is much too long for many clinicians and pathologists; some will only accept death within 1 h from the onset of illness. If the event was not witnessed, sudden death is defined as the interval between the time the subject was last seen and the time the body was found within 6 h.

Ischemic heart disease is easily the most common cause of sudden death followed by a rupture of an aneurysm, almost always of the aorta or a cerebral vessel, pulmonary thromboembolism, and gastrointestinal hemorrhage.

Approximately 69% of sudden deaths attributable to a cardiac cause detected at autopsy are related to structural abnormalities (Van der Werf et al., Circ Arrhythm Electrophysiol. 3:96–104, 2010). These pathologies include ischemic heart disease, cardiomyopathy, myocarditis, and aortic disease, all of which are routinely detected with cardiac imaging antemortem (Van der Werf et al., Circ Arrhythm Electrophysiol. 3:96–104, 2010; Eckart et al. Ann Intern Med. 141:829–834, 2004; Doolan et al., Med J Aust. 180:110–112, 2004).

Moreover approximately 30% of sudden cardiac deaths remain unexplained, maybe due to cardiac arrhythmias in patients with structurally normal hearts.

Radiologic imaging by means of multidetector computed tomography (CT) has led to a great improvement in the diagnosis of diseases such as acute coronary syndrome, pulmonary embolism (PE), aortic dissection, and pulmonary malignancy.