Roberto Lo Gullo MD, Presenter: Nothing to Disclose

Shelly Mishra, Abstract Co-Author: Nothing to Disclose

Diego Alfonso Lira MD, Abstract Co-Author: Nothing to Disclose

Subba Rao Digumarthy MD, Abstract Co-Author: Nothing to Disclose

James R. Stone, Abstract Co-Author: Nothing to Disclose

Mannudeep K. S. Kalra MD, Abstract Co-Author: Nothing to Disclose

Alexi Otrakji MD, Abstract Co-Author: Nothing to Disclose

Sarvenaz Pourjabbar MD, Abstract Co-Author: Nothing to Disclose

Ranish Deedar Ali Khawaja MD, Abstract Co-Author: Nothing to Disclose

Atul Padole MD, Abstract Co-Author: Nothing to Disclose

Sarabjeet Singh MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Toshiba Corporation Research Grant, General Electric Company Research Grant, Koninklijke Philips NV

Fluid in the third space can accumulate in pleural, pericardial and peritoneal spaces in addition to the subcutaneous tissue planes(peripheral edema). We developed a qualitative method for grading fluid in the third space and correlated it with autopsy findings and CT quantitative fluid volume.

Our IRB approved study included 41 human cadavers(mean age 63y, 24M;17F) who had a whole body postmortem CT just prior to their autopsy. All bodies were preserved in the morgue in the time interval between death and autopsy at 4°C(mean time interval between CT and death=23hours). Two radiologists experienced in postmortem imaging reviewed the whole body CT examinations independently to grade the third space fluid in the pleura, pericardium (trace, small, moderate, large), the peritoneum[trace(thin sliver of fluid), small(≤2pockets, each≤5cm), moderate(>2pockets), large(diffuse fluid accumulation)] and subcutaneous space[minimal(fat stranding), mild(subcutaneous fluid in dependent portions), moderate(fluid accumulation extending into intermuscular planes to the non dependent portions), severe(diffuse circumferential fluid accumulation in subcutaneous and intermuscular planes)]. Qualitative grading was correlated with autopsy findings.

No peripheral edema was seen in 9/41 cadavers. Moderate and severe peripheral edema was seen in 14/41 and 8/41 cadavers. It is not possible to quantify peripheral edema on autopsy. Only 26/41(63%) cadavers had concordance between the results from radiologic grading of pleural effusion and the quantity of pleural fluid on autopsy. Only 20/41 and 16/41 of the cadavers (49% and 39%) had concordance between the results from radiologic grading and the quantity of peritoneal and pericardial fluid on autopsy. Degree of anasarca had significant correlation with the severity of ascites(spearman r =0.6,p<0.0001) but not with pleural or pericardial effusion. Results of volumetric estimation of third space fluid on postmortem CT and autopsy will also be presented.

Postmortem CT can help in accurate detection and grading of third space fluid in pleural, peritoneal, pericardial and peripheral tissue planes. Severity of ascites on CT can predict the extent of peripheral fluid accumulation in the body

Third space fluid quantification is feasible on whole body postmortem CT, which is a limitation for autopsy examinations.

Lo Gullo, R, Mishra, S, Lira, D, Digumarthy, S, Stone, J, Kalra, M, Otrakji, A, Pourjabbar, S, Khawaja, R, Padole, A, Singh, S, The Neglected Space: Quantifying the Third Space Body Fluid with Whole Body CT and Autopsy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009699.html