Unusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder

The objective of this case report is the visualization and assessment of ingested or inserted foreign bodies by postmortem computed tomography and autopsy. The presence of foreign objects in the gastrointestinal tract involves, among many other medical subdisciplines, the fields of forensic medicine and psychiatry. We present a case of an 18-year-old female Caucasian with borderline personality disorder who was found unconscious in a closed psychiatric ward with suspected ingested foreign bodies. Cardiopulmonary resuscitation was unsuccessful. Postmortem computed tomography revealed several sharp foreign bodies in the intestine varying in radiodensity and shape but not perforating any anatomic structures. The autopsy showed well-preserved tablets in the intestine, a few inserted glass fragments and one metal fragment. Ultimately, fatal intoxication involving a mixture of opioids, benzodiazepines, neuroleptics and antidepressants resulted. This case illustrates the potential contribution of postmortem computed tomography in diagnosing, localizing and defining ingested and inserted foreign bodies in deceased as well as living individuals. Thus, diagnostic imaging might increase safety not only for the affected individuals but also for medical staff

Postmortem radiological imaging of natural causes of death in adults – a review

Radiological findings of natural causes of death in adults in postmortem imaging are of enormous value for medicolegal investigation. Postmortem computed tomography (PMCT) in particular is increasingly used as a triage tool after external inspection and before a full autopsy. Forensic pathologists and radiologists commonly deal with a wide variety of deaths from natural causes. The most common encountered natural causes of death refer to the cardiovascular, central nervous, respiratory, gastrointestinal and metabolic system. This review provides an overview of the literature on postmortem imaging of the major natural causes of death in adults, categorized by organ systems

Virtopsy concept around the world: Institute-based survey of worldwide forensic postmortem imaging

Introduction: Forensic routine postmortem imaging in excess of photography and conventional X-ray has been pushed since a few years, in some instances under the name ”Virtopsy”. It constitutes a pivotal innovation in forensic medicine as it allows for the non-invasive exploration of the deceased through diverse imaging techniques. This study offers an analysis of a survey with focus on the worldwide adoption and application of postmortem imaging. Our goal is to uncover and understand regional variances in its deployment application. Methods: A survey comprising 18 questions, both closed-ended and open-ended, was designed collaboratively and distributed globally via email and social network. The survey addressed topics such as autopsy rates, imaging modalities, indications for postmortem imaging, personnel involved, evaluation methods, and communication of findings. The survey was initially sent to institutes with published postmortem imaging research, and later, it was distributed through international forensic radiology and radiographer associations. Statistical analysis was conducted to interpret the results. Results: Responses were obtained from 29 countries, representing 6 continents, with a total of 100 participating institutions. European institutions were predominant (69%), followed by Australia (9), North America (8), Asia (7), Africa (6) and South America (1). The majority of institutions reported 100-500 autopsies annually (31). Among the institutes that reported that they perform post mortem imaging (PMI), most listed postmortem computed tomography (PMCT) as modality (89%). The request to perform PMI was issued by institutes of forensic medicine (51%), researchers (42%), police (43%) or public prosecutor’s office (54%). 48% of the respondents stated that an autopsy must always be performed, even if the cause and manner of death can be ascertained by postmortem imaging. radiographers were primarily responsible for technically performing PMCT (65%) whereas physicians were listed in 28%, autopsy technicians in 18%. The majority of the institutions (32%) identified clinical radiologists as the primary individuals responsible for reading, evaluating radiological images, and writing reports. Many respondents (64%) reported that their image readers had attended specialized postmortem imaging courses. Communication of findings typically involved written reports (28%) or a combination of written reports and illustrated images (31%). Membership of survey respondents was indicated in 38% for the International Society of Forensic Radiology and Imaging (ISFRI) and 5% for the International Association of Forensic Radiographers (IAFR). The question was how many of the responders are members of a PMI focused radiological society or work group. 52% (44 out of 85) respondents indicated they were not a member of a postmortem imaging society. The memberships listed are ISFRI (38%), IAFR (5%) and AGFB (Arbeitsgruppe Forensische Bildgebung, 4%). Conclusion: This study provides a global perspective on the utilization of postmortem imaging in forensic medicine, revealing regional variations in practices and technology adoption. It offers insights into the personnel, techniques, and procedures involved in this field in different countries

A fatal case of electrocution with unique forensic radiological postmortem findings

Purpose: Documentation of forensic radiological observations in postmortem imaging of electrical injuries is not common yet and is less prevalent compared to other forms of burn injuries. However, electrical injuries have high morbidity and mortality. The objective of this case report was the visualization and evaluation of unique electrocution-related injuries by postmortem contrast and non-contrast enhanced imaging compared to a forensic autopsy. Methods: Forensic imaging included whole-body postmortem computed tomography (PMCT), PMCT-angiography (PMCTA), postmortem magnetic resonance tomography (PMMR), and PMMR-angiography (PMMRA). Initial external inspection and subsequent autopsy were performed. Results: Imaging results revealed intestinal mucosal pathologies, particularly of the gastric vascular integrity and remarkable rhabdomyolysis of the striated muscles of the extremities. Furthermore, PMCT and PMCTA revealed a hepatic lesion with perihepatic free fluid. The results from external inspection and autopsy correlated to the well-known pathologies of electrocution in the course of a high-voltage incident. Conclusion: Postmortem imaging visualized electrocution-related injuries and aided substantially in the medico-legal investigation. These findings, particularly of the rhabdomyolysis in magnetic resonance tomography, may support the future image interpretation of cases with electrical injuries—in the living and the deceased

Multi-camera system for 3D forensic documentation

Three-dimensional (3D) surface documentation is well established in forensic documentation. The most common systems include laser scanners and surface scanners with optical 3D cameras. An additional documentation tool is photogrammetry. This article introduces the botscan© (botspot GmbH, Berlin, Germany) multi-camera system for the forensic markerless photogrammetric whole body 3D surface documentation of living persons in standing posture. We used the botscan© multi-camera system to document a person in 360°. The system has a modular design and works with 64 digital single-lens reflex (DSLR) cameras. The cameras were evenly distributed in a circular chamber. We generated 3D models from the photographs using the PhotoScan© (Agisoft LLC, St. Petersburg, Russia) software. Our results revealed that the botscan© and PhotoScan© produced 360° 3D models with detailed textures. The 3D models had very accurate geometries and could be scaled to full size with the help of scale bars. In conclusion, this multi-camera system provided a rapid and simple method for documenting the whole body of a person to generate 3D data with Photoscan

Implications for forensic death investigations from first Swiss post-mortem CT in a case of non-hospital treatment with COVID-19

Case details: A case of a 50-year old HIV-positive man is presented, with focus on visualization of post-mortem computed tomography (PMCT) of the lungs, in comparison to a forensic control case. He had been found dead at home, a day after his nasopharyngeal swab had returned positive for SARS-COV-2, three days after the sample had been taken as an outpatient, over five weeks after first exhibiting possible symptoms. 3D-visualization was performed by visually discriminating correlates for aerated, poorly aerated and non-aerated lung regions. The visual side-by-side comparison with a control case shows the deterioration beyond any ”normal” post-mortem finding, however. The PMCT findings in the lungs resemble those of patients with acute respiratory distress syndrome (ARDS), while histologically identified inflammation also shows, in part binuclear, lymphocytes. In addition, acute liver dystrophy and acute tubular necrosis in the kidneys were found. Except coronary artery atherosclerosis, there appeared to be no remarkable pathology of the heart. Comment: With the pandemic impact of SARS-COV-2, a range of issues unfolds, also for medicolegal investigations into deaths, as we report the first Swiss case with post-mortem CT where death had occurred due to a SARS-COV-2 infection, with features of a severe acute respiratory distress syndrome, as an outpatient. As this pandemic from the view of risk assessment does constitute a black swan, underestimated fat tails as technical reason should be addressed by also analyzing apparent extreme single observations. This case of an outpatient (without hospital or intensive-care treatment) shows a pulmonary progression beyond the typical findings of COVID-19, to a non-specific picture of ARDS, where histologically, in part binuclear lymphocytes were remarked. What appeared to be an initially slow progression with final rapid escalation raises the question whether nasopharyngeal swabs alone or added pulmonary CT might be better for screening high-risk patients. The reported symptoms and relatively late medical consultation in this case appeared to contrast with the extensive pathology, raising the question whether any search for super-spreaders should not just focus on asymptomatic but under-reported symptomatic patients, and whether their prolonged circulation in everyday life would justify measures such as for example more extensive face mask policies. As post-mortem testing for SARS-COV-2 may not be available for every case, PMCT may provide sensitive testing for lung changes related to COVID-19. In order to allow for more precise medicolegal investigations in the context of COVID-19, however, any more specific extra tests may have to be financed by stakeholders in epidemiology, infectious disease or policy