James M. Messmer

Radiographic identification of unknown human remains and interpreter experience level.

The use of radiographs as a means of identification of unknown remains is a well-established method as performed by radiologists, forensic anthropologists, or pathologists. We devised a test to determine whether the degree of radiographic and medical knowledge of a film interpreter correlates with the degree of accuracy in making comparisons of radiographic unknowns. Three groups considered to be distinctly different in their level of medical knowledge and radiographic interpretive skills were chosen to evaluate forensic identification cases. Although all three groups identified a majority of cases correctly, none were completely accurate. The group with training in radiographic interpretation performed significantly better. Our study supports the need for trained interpreters in cases of forensic identification.

Personal identification by radiographic comparison of vascular groove patterns of the calvarium.

A case of forensic identification utilizing the vascular grooves within the skull is presented. The case is unique in that the antemortem radiographs were from childhood, rendering useless the more standard points of comparison. Calvarial vascular grooves represent unique points of comparison when the only available premortem radiographs were obtained during childhood, especially when one is attempting to identify children (living or dead).

POSITIVE IDENTIFICATION BY POST-SURGICAL DEFECTS FROM UNILATERAL LAMBDOID SYNOSTECTOMY : A CASE REPORT

The comparison of pre- and postmortem radiographs as a method of identification of unknown human remains is well established in the forensic and radiologic literature. Identification can be based on a single bony feature when there is evidence of prior surgery, trauma or unusual anatomic variation. We present a case in which a positive identification was made using bony changes in the skull secondary to prior surgery for correction of unilateral lambdoid craniosynostosis. The unusual radiographic appearance of the bony defect initially raised the question of trauma and foul play.

Massive Head Trauma as a Cause of Intravascular Air

Three examples of intravascular air caused by massive head trauma are presented. The basic types of air embolism are discussed and the pathophysiology in the three cases is offered. The association should be recognized to avoid misinterpretation of the radiographs.

Treatment of biliary obstruction caused by metastatic cancer

Over an 8-year period, among 41 patients with obstructive jaundice caused by metastases to the liver or lymph nodes adjacent to the porta hepatis, palliative biliary decompression was established surgically in 11, by percutaneous transhepatic biliary drainage (PTBD) in 25, and by both methods in 2. Three patients had no drainage procedure performed. Early mortality after drainage occurred in 6 of 38 patients, and the median survivals (actuarial) for the remaining 32 patients were 4.5 months for the surgical group (range 2 to 21 months) and 4 months for the PTBD group (range 2 to 14 months). Although there were trends toward more frequent hospital readmissions and episodes of cholangitis in the PTBD group, the only statistically significant difference was in the number of catheter manipulations required. We concluded that when patients develop obstructive jaundice as a manifestation of metastatic cancer, useful palliation can be achieved by either surgical or percutaneous decompression.

The Use of Mammographic Equipment in Mass Disaster Identification

Because of its suitability for fine detail radiography, mammographic X-ray film and equipment was found to be well suited to identifying human remains through dental radiography.

Bullet-shaped chest tube tip: potential pitfall in diagnosis.

A potential pitfall in diagnosis with the use of a radiopaque tipped chest tube is reported. A discussion of bullet embolization to and from the heart is given.

Undigested vegetable matter identified on barium-enema examination

Undigested vegetable matter may reach the colon intact and be discovered on barium-enema examination. The authors demonstrate several examples of filling defects in the colon caused by vegetable matter. The characteristic shape and corresponding dietary history should allow for an appropriate diagnosis.

Inadvertent inflation of the balloon: a rare but serious complication of Miller-Abbott intubation

Inadvertent injection of contrast medium or tube feedings into the wrong port of a Miller-Abbott tube can be catastrophic. Four cases are reported, three of which required emergency surgery and two resulted in small-bowel infarction. This complication can easily be avoided if the attending physician and radiologist are aware of the entity.