Post-mortem ultrasound for detecting major fluid collections: a systematic review.

Traditional autopsy is an essential tool for post-mortem diagnosis, but recently acceptance has declined, leading to increased interest in minimally invasive alternatives such as post-mortem ultrasonography (PMUS). The diagnostic test accuracy of PMUS in forensic and perinatal contexts has not been systematically evaluated. Our systematic review aimed to evaluate the accuracy of diagnosis by using PMUS for detection of pericardial tamponade, hemoperitoneum, and hemothorax, using either full autopsy or minimally invasive autopsy (MIA) as a reference standard. Using PubMed, Embase, Scopus, and Web of Science, we conducted a comprehensive literature review on studies evaluating PMUS for detection of post-mortem fluid accumulations, with reference confirmations. Regarding data extraction and quality assessment, we implemented and followed PRISMA-DTA and QUADAS-2 standards. The results were synthesized given the data limitations. Out of four studies, comprising a total of 814 post-mortem examinations (629 adults and 185 perinatal cases), sensitivity of PMUS for pericardial tamponade ranged from 0 to 85%, for free abdominal fluid from 60 to 100%, and for pleural effusion/hemothorax from 0 to 50%. Factors that influenced the results of PMUS were probe selection, operator experience, post-mortem interval, and the individual characteristics of each case. Because of incomplete reporting of denominators and 2 × 2 data, true diagnostic accuracy could not be definitively established or pooled.Generally, PMUS was feasible and rapid, but data were limited by incomplete specificity reporting and methodological variation. PMUS is a promising adjunct tool for identifying major post-mortem fluid accumulations, especially in situations where full autopsy is not feasible. Yet, diagnostic certainty and accuracy are limited by sensitivity variability and data limitations. We recommend that future research focus on uniformity and standardization of imaging protocols, operator training, and validation in larger prospective cohorts to better define the role and applicability of PMUS in forensic and perinatal settings.