Korean J Radiol.  2014 Apr;15(2):205-209. 10.3348/kjr.2014.15.2.205.

Forensic Imaging for Causal Investigation of Death

• Simons D
• Sassenberg A
• Schlemmer
• Yen K

• KMID: 1705574
• DOI: http://doi.org/10.3348/kjr.2014.15.2.205

Abstract

A 63-year-old man was found in the street after overrun by a car. Postmortem CT revealed multiple bone fractures, but surprisingly all without any relevant hemorrhage which would have been expected under such circumstances. A round radiopaque formation was found in the duodenum, which was reminiscent of ingested tablets. The toxicological analysis revealed high concentrations of zopiclone and alcohol. By combining radiologic and forensic results, zopiclone and alcohol intoxication were concluded as the cause of death, followed by a postmortem overrun accident.

Keyword

Computed tomography; Forensic imaging; Virtopsy; Pre-autopsy CT; Forensic reconstruction

MeSH Terms

Accidents, Traffic
Alcoholic Intoxication/*diagnosis
Azabicyclo Compounds/analysis/*poisoning
Duodenum/*radiography
Fatal Outcome
Humans
Hypnotics and Sedatives/analysis/*poisoning
Male
Middle Aged
Piperazines/analysis/*poisoning
Tomography, X-Ray Computed/*methods
Azabicyclo Compounds
Hypnotics and Sedatives
Piperazines

Figure

• 

  Fig. 1 Assessment of main findings to determine cause of death in pre-autopsy computed tomography. A-C. Main findings in pre-autopsy computed tomography (CT). Non-contrast enhanced whole body postmortem CT imaging of 63 years old male overrun victim revealed multiple bone fractures of skull, ribs, vertebrae and extremities (white arrows, A), all without any relevant surrounding hemorrhage. In duodenum, round radiopaque formation (red arrows in A, B) was found which was reminiscent of conglomeration of ingested tablets indicating medication intake before death. Density of radiopaque formation was determined to be 90 Hounsfield units. Hemorrhage was also almost missing in internal organs. Distinct laceration of spleen was documented, also without any relevant surrounding hemorrhage (blue arrow, C). D. In vitro-scan of zopiclone tablets. CT scan of zopiclone tablets was performed. Representative scan of aggregate of five tablets is presented here. E-G. Two-dimensional (2D) and three-dimensional (3D) post-processing possibilities of CT in forensic reconstruction. For visualization in court, in particular 2D and 3D post-processing reconstructions are useful to demonstrate significant findings to medical laity (e.g., judges, lawyers). Significant fractures of humeri were visualized (E, F). Small hematoma of liver capsule (white arrow, G) was also demonstrated to underline that only minor hemorrhage was detected, however man had been overrun.

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