Annie Vesterby

An alternative approach to Computerized Tomography (CT) in forensic pathology

Computerized Tomography (CT) is used by some forensic pathology departments as a supplement to the forensic autopsy. Departments with a limited number of autopsies may find it relatively expensive to acquire and operate a CT-scanner. Furthermore, it requires a great deal of training and experience to interpret the radiological data. We are currently evaluating CT in order to decide whether the benefits match the efforts. In selected death-investigations the Department of Radiology at Aarhus University Hospital performs CT of the body on behalf of the Institute of Forensic Medicine at Aarhus University and a skilled radiologist interprets the data. We present our radiological findings in the 20 cases where we have used CT and compare them to the autopsy findings. The cases include fatalities from beatings, stabbings, gunshots, fires and traffic accidents. CT is an excellent tool for documenting and illustrating certain lesions, such as gunshot wounds and bone fractures, where we can obtain information that possibly would have been missed at the autopsy. We believe, however, that further research is required before we can recommend CT as a part of a standard forensic autopsy. The cooperation between forensic and radiological departments is a good approach for smaller forensic departments that insures a skilled interpretation without having to divert a lot of resources to equipment and training.

Homicidal hanging masquerading as suicide.

Homicidal hanging is rare and presents special problems for the forensic pathologist. We report a case of homicide by hanging masquerading as suicide, in which the forensic evidence was of crucial importance. The victim was a 61 years old man, who was found in his house suspended by a rope around his neck. The autopsy showed fresh bruises due to blunt trauma. Moreover, a voluminous subdural haematoma with brain swelling was found which indicated that the victim was unconscious at the time of the hanging. An obvious vital reaction consisting of cutaneous bleeding in the ligature mark supported the opinion that the deceased was alive and not dead at the time of the hanging. The estimation of the time of death was of great importance, as only one other person could have been present at the estimated time interval. This person was later sentenced to prison for manslaughter.

Iatrogenic fractures of the hyoid bone and the thyroid cartilage. A case report

A case of fracture of the hyoid bone and the thyroid cartilage is reported as a complication to resuscitation. This gave rise to many forensic as well as police investigations and stresses the importance of detailed information at medicolegal autopsies as regards the resuscitation carried out.

The diagnosis of a murder from skeletal remains: a case report.

Abstract A skeletonised body was found in a Danish forest. The examination of the bones revealed several incisions on the skeleton, one located on the cervical column, two on the sternum, one perforating incision to the right iliac crest, and several superficial ones to the ribs and the right tibia. The skeletonized body was thought to be that of a young man in the twenties with a height of 170 cm. It was estimated that the body had been lying at the spot for at least 1 or 2 y and had been murdered by several stab wounds to the chest and abdomen. Police enquiries subsequently revealed that the deceased was a 23-year-old male with a height of 171 cm. A man confessed to having murdered the victim 11/2 years earlier with several stab wounds to the face/neck, chest, abdominal wall and thigh.

Traumatic death in ankylosing spondylitis.

Abstract:  Ankylosing spondylitis (AS) is a chronic rheumatic disease that causes spinal rigidity with an increased risk of spinal fractures. We present a case report where a middle‐aged man, in apparent good health, died following a fall from his bike. Postmortem computed tomography (CT) showed several fractures in the cervical and thoracic spine, with displacement into the spinal canal as well as spinal changes consistent with AS. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fractures that were facilitated by spinal rigidity from AS. Further investigation into the medical records revealed that the decedent had previously been treated for AS. This case report illustrates the importance of obtaining a detailed medical history when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of CT in the evaluation of the mechanism and manner of death.

Dieulafoy lesion of the esophagus causing massive upper gastrointestinal bleeding and death: a case report.

Abstract Dieulafoy lesion is a rare cause of upper gastrointestinal bleeding. We present a case report of sudden and unexpected death in a previously healthy male where autopsy revealed a classic Dieulafoy lesion with a submucosal artery protruding through a small mucosal defect in the esophagus, thereby exposing it to stress and consequent rupture. Advances in endoscopic techniques have drastically reduced mortality from Dieulafoy lesion. Nevertheless, it is an important diagnosis to be kept in mind when autopsy reveals an upper gastrointestinal bleeding.

Atrial fibrillation resulting from cardiac trauma

SummaryReports in the literature concerning isolated traumatic lesions of the conductive system of the heart following blunt injury to the thorax are rare.A 69-year-old woman who was a front-seat passenger developed disturbances of conduction with atrial fibrillation after blunt injury to the thorax. She died 7 days later. Autopsy and subsequent histological investigation of the conductive system of the heart showed isolated contusion in the right atrium close to the atrio-ventricular node.ZusammenfassungIsolierte traumatische Läsionen des Leitungssystemes des Herzens durch stumpfe Traumen werden in der Literatur selten beschrieben.Eine 69jährige Beifahrerin entwickelte nach einem stumpfen Thorax-trauma Leitungsstörungen und Vorhofflimmern und starb eine Woche später. Die Sektion und histologische Untersuchungen des Leitungssystems des Herzens zeigten isolierte Kontusionen des rechten Atriums dicht beim Atrioventrikularknoten.

Chronic Alcohol Abuse Leads to Low Bone Mass with No General Loss of Bone Structure or Bone Mechanical Strength

Chronic alcohol abuse (CAA) has deleterious effects on skeletal health. This study examined the impact of CAA on bone with regard to bone density, structure, and strength. Bone specimens from 42 individuals with CAA and 42 individuals without alcohol abuse were obtained at autopsy. Dual‐energy X‐ray absorptiometry (DEXA), compression testing, ashing, and bone histomorphometry were performed. Individuals with CAA had significantly lower bone mineral density (BMD) in the femoral neck and significantly lower bone volume demonstrated by thinner trabeculae, decreased extent of osteoid surfaces, and lower mean wall thickness of trabecular osteons compared to individuals without alcohol abuse. No significant difference was found for bone strength and structure. Conclusion: CAA leads to low bone mass due to a decrease in bone formation but with no destruction of bone architecture nor a decrease in bone strength. It is questionable whether this per se increases fracture risk.

Sudden death due to rupture of a saccular intracranial aneurysm in a 13-year-old boy.

This case report describes sudden death in a young boy resulting from an undiagnosed saccular intracranial aneurysm located at the right posterior cerebral artery. It is suggested that the rupture might have been provoked by xylometazolin aerosol, which can increase blood pressure.