Spleen measurements with reference to cause of death and spleen weight estimation: A study on postmortem computed tomography

Purpose The spleen is the largest lymphatic organ in the human body. Its appearance and weight during autopsy can be relevant for the determination of cause of death. Postmortem computed tomography (PMCT) supplements traditional autopsy. The aims of this study were to investigate spleen radiodensity on PMCT with regards to prior hospitalization, spleen macroscopy, cause of death, and the utility of PMCT for estimation of spleen weight (SW). Methods Spleen density, width (W), thickness (T), greatest axial surface (S) and presence or absence of contrast medium (CM) residues were evaluated on PMCT axial images of 1035 cadavers retrospectively. Corresponding autopsy reports were reviewed for cause of death, evidence of prior hospitalization, SW at autopsy and macroscopic features of the spleen, like congestion, pallor or contraction. Results Spleen density on PMCT was significantly higher for cases with CM and lower for hospital deaths. Multiple organ failure as cause of death showed significantly lower spleen density than fatal hemorrhage, intoxication, asphyxia-strangulation, hypothermia and metabolic disorders. No significant density differences were noted for different macroscopic spleen findings. Spleen W, T and S strongly correlate with SW at autopsy and formulas for estimating SW were derived based on linear regression models. Conclusions Presence of CM, prior hospitalization and organ failure, fatal hemorrhage, intoxication, asphyxia-strangulation, hypothermia and metabolic disorders as causes of death have an influence on spleen's radiodensity on PMCT. Routine spleen measurements on PMCT can be used to predict SW prior to autopsy or estimate SW when complete forensic autopsy is not conducted.