Reversal sign on ante- and postmortem brain imaging in a newborn: report of one case

A 16-day-old female newborn was admitted to the emergency department after cardiopulmonary arrest. Total-body radiographs and non-enhanced CT of the brain showed fracture of the right clavicle, pericerebral hemorrhage and brain damage with reversal sign. The infant died on the day of her hospital admission. Because child abuse was suspected, a medicolegal autopsy was ordered by the legal authorities. Prior to autopsy, total-body MRI and CT were performed. Results of the ante- and postmortem investigations were compared with each other and then with the autopsy findings. Postmortem brain imaging showed persistence of the reversal sign. To the best of our knowledge, this is the first case describing hypoxic ischemic damage of the brain parenchyma on antemortem CT and persisting on postmortem imaging in a child abuse case.     

Post-mortem changes of the middle ear: multislice computed tomography study

Six dry skulls were studied by multislice computed tomography (MSCT). They had not previously been prepared, and were natural skeletonized remains. All had been found in the soil. Examination focused on the temporal bones and the ear structures. In all cases, either disruption of the ossicular chain or absence of some ossicular bones were noted. The authors concluded that the fragile ossicles were disrupted in the post-mortem state, and were not indicative of ante-mortem pathology. These observations illustrate the ability of MSCT to visualize taphonomic changes. To further illustrate these findings, we present the results of MSCT performed on an exhumed body. The left ossicular bones were missing and the right ossicular chain was disrupted. With the development of forensic radiology, structures as tiny as the ossicles can be examined. However, the radiologist who performs post-mortem imaging must be familiar with taphonomic changes to avoid interpretation as ante-mortem or peri-mortem traumatic injuries. This could potentially have considerable judicial impact, especially in the study of exhumed bodies.     

Thyroid Cartilage Ossification and Multislice Computed Tomography Examination: A Useful Tool for Age Assessment?

Abstract: Many authors have studied the thyroid cartilage ossification process using radiographic features for age estimation of individuals. Their results were various: Sugiyama reported excellent correlation coefficients between ossification rates and civil age, unlike most other authors. We hypothesized that recent advances in imaging techniques would enable more precise evaluation of the ossification of the thyroid cartilage. We retrospectively analyzed the CT scans of 312 French patients using postprocessing software to examine the pattern of thyroid cartilage ossification, calculating the ossified volume of the cartilage on 3D reconstructions. Pearson’s correlation coefficients for volume were 0.73 for men and 0.75 for women (standard error 18.02 and 17.06), indicating considerable inter‐individual variability. Although a correlation between civil age and morphological changes was found, these methods based on thyroid cartilage ossification were not accurate enough for the assessment of individual age.     

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

3D forensic facial approximation: Implementation protocol in a forensic activity

The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three‐dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open‐source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests—which are considered costly for the State or Federation—and consequently reducing the waiting time before delivery of the body to its family.     

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Radiodense bullet wipe around osseous entrance gunshot wounds

“Bullet wipe” is the material deposited by a bullet on any surface with which it comes into contact after it is fired and may contain debris from the gun barrel, including particles of primer and metal fragments from previously fired bullets. X‐ray analysis is a non‐destructive method by which traces of metallic elements can be visually detected. The analysis of osseous defects for radiodense bullet wipe (RBW) assists in determining the presence or absence of perforating gunshot wounds, especially in fragmented, skeletonized remains. The aim of our current study was to determine the frequency of RBW around entrance firearms injuries that perforated bone. We prospectively analyzed entrance gunshot wounds for RBW over a three‐year period using digital X‐ray analysis (n = 59). We retrospectively reviewed the corresponding autopsy reports to determine the frequency of RBW by biologic sex, reported ancestry, age‐at‐death, location of wound, manner of death, range of fire, bullet caliber, and presence of bullet jacket. Data were analyzed by Fisher's exact test or Chi‐square test with significance levels accepted at p < 0.05. RBW was present in 66% (n = 39) of examined cases. Decedent characteristics did not significantly alter RBW distribution, including biologic sex (p = 0.75), reported ancestry (p = 0.49), and age‐at‐death (p = 0.43). Additionally, the location of the osseous entrance gunshot wound, manner of death, range of fire, and cartridge caliber did not affect RBW detection. All cases involving non‐jacketed rounds (n = 5) showed RBW (p = 0.30). To our knowledge, this study is the first to report the frequency of RBW detection from osseous entrance gunshot wounds.     

Human coxal bone sexual dimorphism and multislice computed tomography: geometric morphometric analysis of 65 adults

The authors studied sexually dimorphic differences in coxal shape using geometric morphometric analysis of 15 osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 65 Caucasian adults. Geometric morphometric analysis, principal component analysis, canonical variates analysis, and other discriminant analysis (Goodall's F-test and Mahalanobis distance) were performed for the three separate bones of the left innominate (pubis, ilium, and ischium), the modified pubis (pubis and ischiopubic ramus), the modified ilium (ilium and ischial spine), three bone complexes (ischiopubic, iliopubic, and ilio-ischial), and the complete innominate. A cross-validation test was also performed. All areas studied were dimorphic, but results for sexual dimorphism in decreasing order were as follows: the modified pubis, followed by the ischiopubic complex, the iliopubic complex and the complete innominate, the pubis, the modified ilium, the ilio-ischial complex, the ilium, and finally the ischium. These results show the potential of this approach for future anthropological research.     

Virtual anthropology and forensic identification: report of one case

A charred body was found after a fire in a house in a mountainous region of France. The body was severely burned and was not formally identified as the owner of the house. Autopsy was carried out to seek vital reactions and/or traumatic lesions and to identify the corpse. Before bone preparation and after autopsy, multislice computed tomography (MSCT) was performed in order to assess the potential of the technique for radiological anthropological bone identification. The challenge was to determine as accurately as possible the sex, age, ante-mortem stature and ethnic of the victim using both MSCT and conventional bone study. The results of the two techniques were compared. MSCT provided an answer to all the questions, whereas bone study did not. To the best of our knowledge, this case is the first to use MSCT for forensic anthropological study and illustrates the potential contribution of this technique in this field.