role of virtual autopsy in uncertain clinical scenarios

We present a case of a patient who was transferred from the general ward to the ICU in an unstable condition and passed away within approximately twenty-four hours without having had full investigations due to her unstable clinical condition. In the absence of necessary investigations, a virtual autopsy to search for a medical cause of her rapid deterioration was performed. The virtual autopsy revealed cardio-respiratory failure. Post-mortem computed tomography [PMCT] scans were performed, which revealed that the immediate cause of her deterioration was most likely to have been a myocardial infarction associated with pneumonia

Is it time for a virtual autopsy service in Bahrain?

Post-mortem examination, or autopsy, is known to have been first performed by the ancient Egyptians to prepare the deceased by embalming and other means for their journey into the after-life. In the second century AD, Galen established the concept of autopsy in Rome, albeit mainly in monkeys; this was the first attempt to correlate the physical findings on post-mortem with the symptoms and signs experienced by the patient before death. Autopsy appears to have then become unfashionable or undesirable until the time of the Renaissance and afterwards. In the mid-sixteenth century, Vesalius practiced autopsy and taught it to his students. In about 1543 or 1544, he published De humani corporis fabrica on the composition of the human body based on his post-mortem studies, which is probably the most important anatomy textbook ever published1. Of interest to intensivists, he was the first to describe artificial ventilation by attaching a pair of bellows to a post-mortem trachea-lung preparation. In the nineteenth century, the study of the body post-mortem became more widespread. Doctors such as Rudolph Virchow [Virchow's node] in Germany described an organized technique of carrying out a post-mortem; and much of the progress in western medicine during that time can be attributed to the postmortem study of Virchow and others. The practice of teaching anatomy using cadavers also became widespread during the nineteenth century. Since then, post-mortem science has progressed greatly. It is now possible to extract a healthy infant from the womb of a pregnant woman immediately after death, and it is even possible to harvest the spermatozoa of a dead man, either by the transrectal electro-ejaculation method or by collecting the contents of the epididymis immediately post-mortem. It is important to remember that the harvesting of entire organs for use in transplantation takes place during post-mortem dissection, either with or without a beating heart. The benefits of performing a post-mortem today include: 1. Discovery of the cause of death when the cause is unexplained. 2. As a quality marker, to assess whether the diagnosis and treatment were correct. 3. To assess the effect of treatment given. 4. To look for genetic conditions and give genetic counselling as a result. 5. Teaching medical students and trainee doctors. 6. Forensic purposes. There are particular areas in a hospital where the availability of a post-mortem service is important. Clearly, a patient dying of multiple long-standing illnesses in a hospital medical ward would not usually merit a post-mortem, but a patient dying of a sudden unexplained illness in an emergency department or an adult Intensive Care Unit would need post-mortem investigation to determine the cause of death and to rule out foul play. In addition, neonates and older children dying of unexplained conditions need to have their cause of death investigated to satisfy the parents' unanswered questions and to establish the presence or otherwise an inherited cause of death. It has been a source of considerable frustration to the first author that no post-mortem study has been possible in patients where the cause of death has not been fully explained. Different religions have different views on post-mortem study. No religion encourages it. Christianity tolerates it as a necessary aspect of science. However, Muslims, Hindus and Jews have similar views; all three religions object to post-mortem dissection on three grounds: first, the body should be moved as little as possible, second, the integrity of the body as a whole must not be compromised, and third, post-mortem delays burial [or cremation in the case of Hindus] as burial should take place quickly, preferably on the same day. It is probably reasonable to assume that all religions in olden times viewed corpses as a potent source of infection, and were anxious for burial or cremation to take place as soon as possible after death