Postmortem changes in musculoskeletal and subcutaneous tissue

Objectives: The changes of the body after death as visible on postmortem CT (PMCT) need to be differentiated as either normal postmortem physiology (such as hypostasis) or a sign of antemortem pathology (such as infection) or treatment (such as resuscitation). We investigated the subcutaneous and musculoskeletal tissues and correlated the attenuation with the postmortem interval (PMI) and pathology.

Methods: Cadavers that were donated to medical science, had a PMCT every hour. Clinical cadavers with a PMCT were included. The attenuation of subcutaneous and musculoskeletal tissues on the ventral and dorsal side of the body were measured. The PMI, temperature, antemortem infectious disease and attempted resuscitation were correlated to the attenuation. Anterior and posterior attenuation ratios were compared to determine gravitational effects over time.

Results: Five science cadavers were included with PMCT hourly from 4 to 48 h after death. 53 clinical cadavers were included. The ratio of ventral to dorsal muscle attenuation decreased over time in all five science cadavers. Attenuation of fat and musculoskeletal tissues showed large interpersonal differences without a consistent correlation to the PMI. Infectious cadavers showed some lower muscular attenuations than non-infectious cadavers. No attenuation effects of resuscitation could be found on PMCT.

Conclusion: Postmortem subcutaneous and musculoskeletal PMCT attenuation changes are common, however with substantial interpersonal differences. No correlation to PMI, body temperature or resuscitation was demonstrated. Infectious disease correlated to lower attenuation in some but not all muscles. Decreasing attenuation ratios in ventral-to-dorsal muscle tissue over the PMI may be a gravitational effect. Additional research is required to further explain the findings.