Characteristic findings of chest post-mortem computed tomography in stillbirths: A report of three cases

• We investigated PMCT potential to distinguish stillbirths from live births. • In stillbirths, the course of the ductus arteriosus is traceable on PMCT. • Absence of gas in the main and lobar bronchi was observed despite attempted resuscitation. • PMCT may help differentiate stillbirths from live births in forensic practice. Distinguishing between live births and stillbirths is substantially important in forensic autopsies. Lung-gastric flotation tests and histopathological examinations have been widely used for determining the diagnosis. In addition, postmortem computed tomography (PMCT) has recently been investigated as a potential diagnostic tool. In this report, we investigated the characteristic PMCT findings of stillbirths in three forensic autopsy cases. PMCT was performed in three male newborns (estimated gestational age: 7–9 months) with postmortem intervals of 10 hours (Case 2), 2 days (Case 1), and 1 week (Case 3). All cases comprised out-of-hospital deliveries: two infants were transported to the hospital after birth, while one was found deceased. In each case, the lungs and gastrointestinal tract sank during the flotation test, and no microscopic alveolar dilation was observed, leading to a diagnosis of stillbirth. The mean CT value of the lung field ranged between 42.1 and 49.0 Hounsfield units, indicating soft tissue-like density. In all cases, the ductus arteriosus appeared to be more dilated than did the left and right pulmonary arteries. No gas or fluid was detected in the main or lobar bronchi among all cases. This study is limited by the small number of cases with all being stillbirths. However, the imaging findings described in these cases of stillbirth suggest that PMCT might contribute to the differentiation between live births and stillbirths. In conclusion, the combination of high lung field density, ductus arteriosus patency, and absence of gas in the main and lobar bronchi on PMCT suggests a characteristic pattern of stillbirths.