Thoracoscopy vs conventional autopsy of the thorax. A promising perspective.

Objective: To analyze the sensitivity and specificity of thoracoscopic autopsy compared with that of conventional postmortem examination.

Design: Consecutive sampling, case-series study.

Setting: A general community referral center and the local Institute of Forensic Medicine.

Participants: A consecutive sample of 20 fresh cadavers (less than 24 hours old), victims of motor vehicle crashes, gunshot wounds, in-hospital deaths.

Interventions: Introduction of the thoracoscope through the fourth or fifth intercostal space, anterior or midaxillary line. The pleural cavity and mediastinum were examined. Formal postmortem examination was then performed, and the findings of both procedures were recorded, compared, and analyzed.

Main Outcome Measures: Prior to the beginning of the study, it was hypothesized that thoracoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the thoracic cavity and mediastinum in search of trauma-related abnormalities in trauma victims or cause of death in in-hospital patients.

Results: There was an 85% correlation of both procedures in all cases. The sensitivity of thoracoscopic autopsy was 87% and overall specificity reached 72%.

Conclusions: Thoracoscopic autopsy is accurate and easy to perform. It is highly sensitive, especially in deaths due to trauma and following thoracic surgery. Thoracoscopic autopsy is an important tool that allows the diagnosis of major chest abnormalities as well as ruling out postoperative catastrophe, information that is invaluable for the surgeon, as well as all the medical staff and families. Thoracoscopic postmortem examination should be offered to mourning families as a cosmetic and reliable option when informed consent for conventional autopsy is lacking.