Peter Mygind Leth

Computerized tomography used as a routine procedure at postmortem investigations.

This is a prospective investigation of a consecutive series of 250 deceased individuals who were computerized tomography (CT)-scanned and autopsied. In 13% of patients, important findings at the CT-scanning were not found at the autopsy, and in 48% of patients, important autopsy findings were not found at the CT-scanning. The cause of death could be established by CT in 31%, by autopsy in 74%, and by toxicology in 22%. CT combined with data from the inquest could establish the cause of death in a majority of deaths due to severe trauma, but only in a minority of deaths caused by disease or poisoning. We found the Siemens Somatom Spirit dual-slice CT-scanner cost effective, quick, and well suited as a supplement to the routine autopsy. CT is useful in identifications, gunshot lesions, and traffic accidents. CT allows investigation of anatomic regions that are not easily available by autopsy and allows fractures and inner organs to be seen “in situ.” CT provides documentation in digital form – easily stored – permits review by others and provides pictures that may be more suitable for presentation in court than autopsy photos.

Terminology used in publications for post-mortem cross-sectional imaging

We write to you today to suggest the need for standardisation of terminology used in the forensic/autopsy journals in the ever increasing number of publications in the emerging field post-mortem cross-sectionalimaging.Inouropinion,thereare too many different terms used currently both as words and/or abbreviations and the time has come to propose within the forensic literature that common terminology be applied to this field. The introduction of standardised terminology is critical, not only for those endeavouring to write and publish their work but also for those attempting to find references by keyword searches. We suggest the following terminology be introduced to initiate the process of standardisation: 1. Currently, the two modalities emerging as dominant in post-mortem imaging are computed tomography and magnetic resonance imaging. We propose, as has been adopted within the UK, these be generically referred to as post-mortem cross-sectional imaging, so both modalities are covered by a single phrase. Authors could then go on to specify which of the two modalities, i.e. post-mortem computed tomography or postmortem magnetic resonance imaging or both, are referred to within their work. 2. In the case of post-mortem computed tomography, we propose the abbreviation PMCT be used. In the case of

The use of CT scanning in forensic autopsy.

Postmortem computed tomography (CT) is being used more frequently in forensic medicine. This review discusses 100 deceased individuals who underwent CT scanning, as well as a standard autopsy. The CT scan was performed and interpreted by a forensic medicine specialist. In 11 cases, important findings discovered during the CT scan were not found at autopsy, and in 58 cases, important findings revealed at autopsy were not uncovered during the CT-scan. The cause of death could be established by the CT scan and external examination in 27%; by CT scan, external examination, and forensic chemistry in 32%; and by autopsy in 95% of the cases. CT scanning was most useful in cases of traumatic death. CT is rarely a substitute for autopsy, but may contribute important new information in cases such as identifications (particularly following mass disasters), battered children, gunshot wounds, traffic accidents, and air embolisms. CT provides documentation in digital form, which is easily stored and permits review by others. CT also provides pictures that may be more suitable for presentation in court than autopsy photos. CT scanning also would be helpful during a medicolegal external examination (inquest) in the process of selecting cases for autopsy.

Interobserver agreement of the injury diagnoses obtained by postmortem computed tomography of traffic fatality victims and a comparison with autopsy results

The present study investigated the interobserver variation between a radiologist and a forensic pathologist in 994 injury diagnoses obtained by postmortem computed tomography (CT) of 67 traffic fatality victims, and the results were compared with diagnoses obtained by autopsy. The injuries were coded according to the abbreviated injury scale (AIS). We found a low interobserver variability for postmortem CT injury diagnoses, and the variability was the lowest for injuries with a high AIS severity score. The radiologist diagnosed more injuries than the pathologist, especially in the skeletal system, but the pathologist diagnosed more organ injuries. We recommend the use of a radiologist as a consultant for the evaluation of postmortem CT images. Training in radiology should be included in forensic medicine postgraduate training. CT was superior to autopsy in detecting abnormal air accumulations, but autopsy was superior to CT in the detection of organ injuries and aortic ruptures. We recommend a combination of CT and autopsy for the postmortem investigation of traffic fatality victims.

The distribution of mercury and other trace elements in the bones of two human individuals from medieval Denmark – the chemical life history hypothesis

Excavating human skeletons is the closest archaeologists can get to the people who lived in the past. Once excavated the bones are often analysed chemically in order to yield as much information as possible. Most archaeometric analyses performed on samples of human skeletal remains have been performed on a single sample from a tooth or a long bone. In this paper we investigate how a suite of elements (Mg, Al, Ca, Mn, Fe, Zn, As, Sr, Ba, Hg and Pb) are distributed in two medieval skeletons excavated at the laymen cemetery at the Franciscan Friary in Svendborg, Denmark.The analyses have been performed using CV-AAS for Hg and ICP-MS for the rest of the elements. We find that in general Hg concentrations are highest in the trabecular tissues and in the abdomen region. Our data also show that the elements Al, Fe and Mn concentrate in the trabecular tissue and on the surfaces of the bones. The two individuals can be clearly distinguished by Principal Component Analysis of all the measured trace elements.Our data support a previously published hypothesis that the elemental ratios Sr/Ca, Ba/Ca and Mg/Ca are indicative of provenance. Aluminium, Fe and Mn can be attributed to various forms of diagenesis, while Hg is not present in sufficiently large amounts in the surrounding soil to allow diagenesis to explain the high Hg values in the trabecular tissue. Instead we propose that Hg must originate from decomposed soft tissue.

Spinal cord injury at birth: a hidden causative factor

A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non‐traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co‐morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously.

Post-mortem toxicology in young sudden cardiac death victims: A nationwide cohort study

Aims Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P < 0.01). In total, 752 agents were detected, and polypharmacy (defined as the presence of more than one drug) was present in 61% (n = 164), all substances combined. Psychotropic drugs were the most frequent (62%, n = 467), and 82% (n = 385) were in pharmacological or subpharmacological levels. Conclusion We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.

Suffocation caused by plastic wrap covering the face combined with nitrous oxide inhalation

Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.

Visualisation of contrast-filled stab wounds in various tissue types with computed tomography

ABSTRACT Background: Stab wounds are common in homicide cases. Post-mortem multislice computed tomography (PMCT) has proved to be a useful tool in forensic examinations of victims of sharp force trauma, but due the limited resolution of soft tissues, the radiological depiction of a stab channel is difficult. In this study, we have tried to obtain information about the shape of a knife blade by CT scanning contrast-filled experimentally inflicted stab wounds in various types of pig tissue. Methodology: The tissue samples were mounted on floral foam (oasis) with wooden sticks. Two contrast media were used: one was unmodified and easy flowing, and one was made more viscous with polyethylene glycol. Stab channels in ballistic soap were used for comparison. India ink-filled stab channels were investigated histologically to determine the pattern of leakage. Principal findings: We found that the shape of the stab wounds on the CT images from lung and muscle tissue did not correspond well to the shape of the inflicting knife. There was a better correspondence in the images obtained from liver, spleen and kidney. The viscous contrast medium was less likely than the thin (easy flowing) contrast medium to spill into to structures outside the stab channel, but some spillage was observed for both types of contrast medium. Air bubbles were only observed in the viscous contrast medium. Conclusion: Radiological evaluation of a contrast-filled stab wound in isolated tissue blocks did not permit the positive identification of the inflicting weapon, but it was, in tissue blocks from liver, spleen and kidney, possible to obtain a rough idea of the shape of the inflicting knife and to differentiate a knife from a screwdriver.

Unusual accidental decapitation in a road traffic incident

Decapitation is an occurrence only rarely encountered in forensic medical practice. This fatality is generally most often described in pedestrians who have been run over by trains accidently or in cases of suicide, or alternatively in occupants of cars involved in high speed vehicle collisions. We report, for the first time, a case of a complete decapitation of a pedestrian as a consequence of a traffic accident. Due to a thorough medico-legal investigation of the body and the involved vehicle, we were able to reconstruct the unique dynamics of the accident and the mechanism of injury.