OBJECTIVE. The purpose of our study was to define the postmortem CT semiology of gas collections linked to putrefaction, postmortem "off-gassing," and
decompression illness after fatal diving accidents and to establish postmortem CT diagnostic criteria to distinguish the different causes of death in diving. SUBJECTS AND METHODS. A 4-year prospective study was conducted including cases of death during diving. A hyperbaric physician analyzed the circumstances of death and the dive profile, and an autopsy was performed. Subjects were divided into three groups according to the analysis from their dive profile:
decompression illness, death after
decompression dive without
decompression illness, and death after nondecompression dive without
decompression illness. Full-body postmortem CT was performed before autopsy. RESULTS. The presence of intraarterial gas associated with death by
decompression illness had a negative predictive value (NPV) of 100%, but the positive predictive value (PPV) was only 54% because of postmortem off-gassing. The PPV reached 70% when considering pneumatization of the supraaortic trunks.
Pneumothorax,
subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for
decompression illness diagnosis, are not specific for
decompression illness. CONCLUSION. This study is the first to show that
pneumothorax,
subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for
decompression illness diagnosis, are not specific for
decompression illness. Complete pneumatization of supraaortic trunks is the best postmortem CT criteria to detect a fatal
decompression illness when CT is performed within 24 hours after death.