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

Using the iPhone's LiDAR technology to capture 3D forensic data at crime and crash scenes

Background: Three-dimensional (3D) documentation of crime and crash scenes is common practice during forensic and medicolegal investigations. Such documentation at a scene is usually carried out by specially trained personnel using various 3D imaging devices and methods, such as terrestrial laser scanners. Unfortunately, this causes the implementation of 3D documentation at the scenes to be expensive and not readily accessible. In 2020, Apple introduced a light detection and ranging (LiDAR) sensor into their high-end mobile devices. In 2022, Recon-3D, an iOS application (app), was launched. This app turns an iPhone or iPad into a 3D scanner and is specifically targeted at crime and crash scene applications. Objectives: The aim of this study was to test the Recon-3D app based on exemplary scenarios to see whether this technology is generally applicable to document crime or crash scenes. Materials and Methods: An iPhone 13 Pro in combination with the Recon-3D app was used to document two indoor scenarios, a mock-up crime scene and a garage, as well as an outdoor scenario of a parked car. Each scenario was documented multiple times. Results: On average, data acquisition for one scene took less than 2 min. Known distances within the scenes were measured with a mean absolute error of 0.22 cm and a standard deviation of 0.18 cm. Conclusion: The imaging workflow was simple and quick, enabling any person to perform 3D documentation at a crime or crash scene. Overall, Recon-3D appeared to be a useful application for forensic investigators

Comparison of very affordable immersion pump and heart-lung-machine for post mortem CT angiography in forensic pathology – A case-control study

Full body post mortem CT angiography (PMCTA) in forensic medicine started on a larger scale with relatively expensive roller-pumps for what in essence seems to be a task consisting of pumping mostly homogenous contrast fluids. At considerably lower cost, centrifugal pumps are a technically powerful alternative. We compare a very affordable immersion pump (IP) with a heart lung machine (HLM) for an iodine based vascular contrast agent in a age-sex matched case-control study of 10 each. The IP outperformed the HLM, in part with statistical significance, depending on the aspect or metric that was compared. Concluding, the IP may be preferred as a useful and affordable alternative over a more expensive roller-pump

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

The possibility of identifying brain hemorrhage in putrefied bodies with PMCT

This paper aims to demonstrate that post-mortem CT (PMCT) can locate intracranial hemorrhages, even in decomposed cases. This is of relevance in that post-mortem decomposition is particularly damaging to the brain tissue’s consistency, resulting in great difficulties to reliably diagnose and locate intracranial hemorrhages. We searched our case database of the last 11 years to find cases with decomposition of the body, where PMCT and an autopsy had been performed. We identified eleven cases according to these criteria. Postmortem interval ranged from 2 days to 2 weeks, and post-mortem radiological alteration index (RAI) was at or above 49. Eight out of eleven cases showed an intraparenchymal hemorrhage whereas the hemorrhage was extra-axial in the remaining three cases. Autopsy validated the presence of intracranial hemorrhage in all eleven cases, but location could not be confirmed due to liquid state of the brain. PMCT identified and localized intracranial hemorrhages in decomposed bodies, and in all of these cases, autopsy validated their presence. The actual cause of the hemorrhage (e.g. tumor, metastasis, vascular malformation, hypertensive hemorrhage) remained obscure. From this case series, it can be concluded that PMCT may add relevant information pertaining to localization of intracranial hemorrhages in decomposed bodies

Diagnostic accuracy of postmortem computed tomography for bleeding source determination in cases with hemoperitoneum

Aim: The aim of this retrospective study was to determine the accuracy of postmortem computed tomography and different radiological signs for the determination of the bleeding source in cases with hemoperitoneum confirmed at autopsy. Methods: Postmortem computed tomography data of consecutive cases with hemoperitoneum confirmed at autopsy were reviewed by two raters, blinded to the autopsy findings. The determination of possible bleeding sources was based on the presence of the sentinel clot sign, blood or sedimented blood surrounding an organ, intraparenchymal abnormal gas distribution, and parenchymal disruption. The bleeding source and the cause of hemoperitoneum (traumatic, surgical, natural, or resuscitation) as reported in the autopsy report were noted. The survival intervals of the deceased were calculated when information about the time of an incident related to death was available in the autopsy reports. Results: Eighty-five cases were included in the study. Postmortem computed tomography showed 79% sensitivity and 92.1% specificity for the detection of the bleeding source. The sentinel clot sign was associated with surgical or natural causes of hemoperitoneum and longer survival intervals. Sedimented blood around the bleeding source was associated with resuscitation. Abnormal gas distribution within organs and combination of multiple radiological signs provided higher sensitivity. Conclusion: Postmortem computed tomography provides moderate sensitivity and high specificity for determining the bleeding source in cases with hemoperitoneum. Different PMCT signs are associated with different causes of hemoperitoneum and survival intervals

Prevalence of calcified epiglottis in postmortem computed tomography. Is there a correlation to failed endotracheal intubation?

Objectives: Calcification of the epiglottis is a normal physiological degenerative process, although it can also be a consequence of infection or trauma. There are three possible forensically relevant consequences from epiglottic calcification: misinterpretation as foreign bodies, dysphagia as a major contributing factor to aspiration, and association with difficult intubation or a misplaced ventilation tube. It is the aim of this study (I) to inquire about the prevalence of epiglottic calcification in postmortem CT in general and (II) to investigate whether calcification of the epiglottis is linked to a higher incidence of failed endotracheal intubation. Methods: We retrospectively analysed 2930 consecutive cases in postmortem CT at the Institute of Forensic Medicine. Results: The prevalence of epiglottic calcification was 4.1%. Higher age and male sex are associated with an increased risk of epiglottic calcification. There was no calcification of the epiglottis in the cases with misplacement of the ventilation tube in the esophagus. Conclusions: To verify the result of our study, that is, the calcification of the epiglottis is not linked to a higher incidence of failed endotracheal intubation, it might be reasonable to repeat this study with a more representative study population. The high interindividual variations of calcified epiglottis could be used for identification

Cinematic rendering of a burst sagittal suture caused by an occipito-frontal gunshot wound

The computed tomography (CT) scan of a 19-year-old man who died from an occipito-frontal gunshot wound presented an impressive radiating fracture line where the entire sagittal suture burst due to the high intracranial pressure that arose from a near-contact shot from a 9 mm bullet fired from a Glock 17 pistol. Photorealistic depictions of the radiating fracture lines along the cranial bones were created using three-dimensional reconstruction methods, such as the novel cinematic rendering technique that simulates the propagation and interaction of light when it passes through volumetric data. Since the brain had collapsed, depiction of soft tissue was insufficient on CT images. An additional magnetic resonance imaging (MRI) examination was performed, which enabled the diagnostic assessment of cerebral injuries

Illustrated argument for CT-scanning a whole car for the forensic investigation of projectile holes, defects, fragments and possible trajectories

Contemporary documentation of a car with bullet defects after a shooting incident can secure the usual tracks and gunshot residue, take photographs, and use trajectory rods and probes. Since the advent of the ”XXL-CT -Scanner” (Fraunhofer Institute, Germany), we have wondered if the advantages of volume scanning CT, already noted for forensic pathology, could be applied to cars. To this end, we damaged a small 3D-printed car model with an electric drill and added CT -dense material with a soldering iron, simulating linearly configured defect morphologies with metal particles. This model was CT -scanned and the resulting data visualized to illustrate how these visualizations can support reconstructive visualization of trajectories. Performing a real XXL-CT scan of a bullet-riddled car requires extensive preparation, transportation, and other logistical measures that are costly and time-consuming. Nonetheless, we suggest that this is a worthwhile research direction to explore