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Tarozzi I, Franceschetti L, Simonini G, Raddi S, Machado D, Bugelli V. Black box of diving accidents: Contribution of forensic underwater experts to three fatal cases. Forensic Sci Int 2023; 346:111642. [PMID: 36963130 DOI: 10.1016/j.forsciint.2023.111642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Diving is a popular activity, largely practiced worldwide. Diving fatalities are not rare events, with drowning being the most common cause of death, followed by cardiac-related natural causes, immersion pulmonary edema and arterial gas embolism. In such cases, positive signs of drowning are not specific, depending also on the time of submersion of corpses. Moreover, drowning can be the terminal event. Over the years, measures to perform appropriate post-mortem examination in cases of diving fatalities were suggested, including the execution of post-mortem CT-scan, the use of a decompression chamber and the adoption of specific autoptic techniques. Although a multidisciplinary approach in forensic investigations concerning diving fatalities is discussed, poor cases focus on how the analysis of diving computer records and equipment can contribute to determining the cause of death. The present study shows how the cooperation between a forensic underwater expert and a forensic pathologist played a crucial role in interpreting radiological findings, guiding the autopsy and confirming/denying circumstantial data emerging from the investigations. Technical analysis of dive computer records and diving equipment is a fundamental step in the definition of the cause of death in diving fatalities. All diving computer data, not only those related to maximum depth and ascent's profile, should be considered in detail, and the immersion graph carefully studied by both the forensic pathologist and the forensic underwater experts. The diving technical data can often play a crucial role in explaining any legal issue related to the circumstances of death, possibly leading the prosecutor to further investigation.
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Affiliation(s)
- Ilaria Tarozzi
- Modena Local Health Unit, Department of Legal Medicine and Risk Management, Modena, Italy
| | - Lorenzo Franceschetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
| | | | - Silvia Raddi
- Health Science Department, Forensic Pathology Section, University of Florence, Florence, Italy
| | - Davide Machado
- South-East Tuscany Local Health Unit, Department of Neuroradiology, Grosseto, Italy
| | - Valentina Bugelli
- South-East Tuscany Local Health Unit, Department of Legal Medicine, Grosseto, Italy
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Giaconi C, Manetti AC, Turco S, Coppola M, Forni D, Marra D, La Russa R, Karaboue M, Maiese A, Papi L, Turillazzi E, Neri E, Di Paolo M. Post-mortem computer tomography in ten cases of death while diving: a retrospective evaluation. Radiol Med 2022. [PMID: 35050453 DOI: 10.1007/s11547-022-01448-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Self-contained underwater breathing apparatus (SCUBA) diving deaths have always been a challenge for forensic pathologists. Post-mortem computer tomography (PMCT) allows intracorporeal gas visualization, contributing to identify the cases in which the cause of death is arterial gas embolism (AGE). However, in the literature, it is indicated to perform the radiological examination within 24 h after death. MATERIALS AND METHODS In this retrospective study, 32 cases of death who had undergone PMCT 24-48 h after death/corpse finding between January 2011 and March 2021 were analyzed, including ten cases of SCUBA divers who died of AGE. All cases' radiological images were reviewed to localize the intracorporeal gas distribution alongside other findings that are usually related to SCUBA diving death. A semi-quantitative evaluation was also performed. RESULTS Most of the divers showed gas within the left heart and the arteries. In addition, the semi-quantitative evaluation revealed that the divers presented a higher mean amount of intraarterial gas compared to the fresh corpses. On the other hand, the putrefied corpses presented gas within the portal system and generalized subcutaneous emphysema with higher frequency and quantity than the divers and fresh corpses. CONCLUSION Our cases suggested that the PMCT, even when performed 24-48 h after death, remains a valuable tool to diagnose AGE in cases of SCUBA diving deaths. In addition, with the limit of the small sample size, our data showed that at least a medium quantity of intraarterial gas, when not associated with a high amount of gas within the portal system and subcutaneous emphysema, could be considered a diagnostic criterion of AGE.
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Wang Y, Liu N, Yang M, Tian Z, Dong H, Lu Y, Zou D. Application and Prospect of Postmortem Imaging Technology in Forensic Cardiac Pathology: A Systemic Review. J Forensic Sci Med 2022. [DOI: 10.4103/jfsm.jfsm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Serinelli S, Richardson TE, Destian S, Mirchia K, Williams M, Medina-Perez M, Gitto L. Head and Brain Postmortem Computed Tomography-Autopsy Correlation in Hospital Deaths. Am J Forensic Med Pathol 2020; 41:163-75. [PMID: 32618580 DOI: 10.1097/PAF.0000000000000538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of postmortem computed tomography (PMCT) to support autopsy pathology has increased in recent decades. To some extent, PMCT has also been contemplated as a potential alternative to conventional postmortem examination. The purpose of this study was to investigate the ability of PMCT to detect specific pathologic findings in the head and brain in natural hospital deaths.We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY (State University of New York) Upstate University Hospital between 2013 and 2018. Each subject underwent a noncontrast PMCT and a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results.In our series, PMCT was able to detect the majority of the significant space-occupying lesions, although it was not always reliable in ascertaining their nature. Postmortem computed tomography revealed findings usually challenging to detect at autopsy. Unfortunately, there were also situations in which PMCT was misleading, showing changes that were difficult to interpret, or that could be related to postmortem events. Therefore, we conclude PMCT should be used as an adjunct rather than a substitute to autopsy.
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Lee H, Lee S, Cha JG, Baek T, Yang K. Postmortem Computed Tomography and Computed Tomography Angiography: Cardiothoracic Imaging Applications in Forensic Medicine. J Thorac Imaging 2019; 34:286-98. [DOI: 10.1097/rti.0000000000000398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Ducloyer M, Tuchtan L, Delteil C, Piercecchi MD, David A, Visseaux G, Bouvet R, Gorincour G, Clement R. Lung density measurement in postmortem computed tomography: a new tool to assess immediate neonatal breath in suspected neonaticides. Int J Legal Med 2019; 134:1159-1166. [PMID: 31286205 DOI: 10.1007/s00414-019-02103-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
INTRO Evidence of breath after birth is one of the main forensic issues in suspected neonaticide. Hydrostatic test (HT) and pathological examination are currently used to assess it, but they are not entirely reliable or immediately available. OBJECTIVE To determine the performance of postmortem computed tomography (PMCT) to assess neonatal breath in suspected neonaticide, by comparing lung CT attenuation values between live birth and stillbirth cases, in correlation with HT and pathology. METHOD Cases of suspected neonaticides who underwent a PMCT and complete forensic autopsy with an HT were retrospectively selected from the databases of four French Forensic Medicine Departments. The diagnosis of vitality (i.e., stillbirth or live birth) was based on the pathological examination and/or a combination of arguments, including HT result. Lung density on CT was measured in Hounsfield units (HU) by ROIs drawn in both pulmonary parenchymas. RESULTS Eleven patients were included, six live birth and five stillbirth cases. The result of HT was concordant with pathological examination when available (seven cases). Mean lung densities in live birth cases (- 173 HU [- 255; - 91 CI 95%]) were significantly lower than in stillbirth cases (40 HU [28; 52 CI 95%]) (p < 0.05), with a very high degree of interobserver reproducibility (ICC = 0.998 (CI 95% 0.991-0.999; p < 0.001). CONCLUSION PMCT and especially lung CT attenuation measurement is a reliable and easy-to-use method for assessing neonatal breath in suspected neonaticides.
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Affiliation(s)
- Mathilde Ducloyer
- Forensic Medicine Department, Centre Hospitalier Universitaire de Nantes, 30 Boulevard Jean Monnet, 44000, Nantes, France. .,Department of Radiology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - Lucile Tuchtan
- Forensic Medicine Department, APHM, Hopital de la Timone, Marseille, France.,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France
| | - Clémence Delteil
- Forensic Medicine Department, APHM, Hopital de la Timone, Marseille, France.,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France
| | - Marie-Dominique Piercecchi
- Forensic Medicine Department, APHM, Hopital de la Timone, Marseille, France.,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France
| | - Arthur David
- Department of Radiology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Guillaume Visseaux
- Forensic Medicine Department, Centre Hospitalier Universitaire de Nantes, 30 Boulevard Jean Monnet, 44000, Nantes, France
| | - Renaud Bouvet
- Forensic Medicine Department, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, IDPSP EA 4640, Rennes, France
| | - Guillaume Gorincour
- Laboratoire d'Imagerie Interventionnelle et Expérimentale, LiiE, EA4264, Aix Marseille Université, Marseille, France
| | - Renaud Clement
- Forensic Medicine Department, Centre Hospitalier Universitaire de Nantes, 30 Boulevard Jean Monnet, 44000, Nantes, France
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Dougherty S, Khorsandi M, Adelbai M, Zamvar V, Francis J. Sudden Death in a Diver: A Diagnostic Conundrum. Wilderness Environ Med 2017; 28:225-9. [PMID: 28501412 DOI: 10.1016/j.wem.2017.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
We discuss the case of an experienced diver who ran out of air during his final ascent while scuba diving. He lost consciousness rapidly after surfacing and despite immediate cardiopulmonary resuscitation, could not be revived. On arrival at the emergency department he was noted to have copious amounts of blood in his upper airway and had developed extensive subcutaneous emphysema. Large amounts of air were observed in the central circulation following a postmortem computerized tomography scan as well as pneumomediastinum, a small right-sided hemothorax, and extensive subcutaneous emphysema. We discuss several potential pathophysiological mechanisms that might explain these findings. Finally, we end with a recommendation for an expedient whole-body postmortem computerized tomography scan and autopsy by a suitably qualified pathologist in the investigation of all dive-related fatalities, where possible.
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Garetier M, Deloire L, Dédouit F, Dumousset E, Saccardy C, Ben Salem D. Postmortem computed tomography findings in suicide victims. Diagn Interv Imaging 2017; 98:101-112. [DOI: 10.1016/j.diii.2016.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/05/2023]
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Yanagawa Y, Kondo A, Yoshizawa T, Jitsuiki K, Miyake T, Ohsaka H, Sugita M. The Migration of Air into the Aorta from a Pneumothorax in a Patient with a Penetrating Injury of the Aorta. Aorta (Stamford) 2016; 4:102-104. [PMID: 28097188 DOI: 10.12945/j.aorta.2016.16.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/12/2016] [Indexed: 11/18/2022]
Abstract
A tree fell on the back of a 77-year-old male. A postmortem computed tomographic pan scan revealed systemic air embolism, multiple rib fractures with a penetrating injury to the aorta, pneumohemothorax, and air in the aorta. A massive amount of air entered the site of a penetrating injury of the aorta. This unique case adds one more cause to the list of documented etiologies of air in the aorta.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
| | - Toshihiko Yoshizawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Takahito Miyake
- Department of Orthopedics, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
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Bernaldo de Quirós Y, Saavedra P, Møllerløkken A, Brubakk AO, Jørgensen A, González-Díaz O, Martín-Barrasa JL, Fernández A. Differentiation at necropsy between in vivo gas embolism and putrefaction using a gas score. Res Vet Sci 2016; 106:48-55. [PMID: 27234535 DOI: 10.1016/j.rvsc.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/18/2022]
Abstract
Gas bubble lesions consistent with decompression sickness in marine mammals were described for the first time in beaked whales stranded in temporal and spatial association with military exercises. Putrefaction gas is a post-mortem artifact, which hinders the interpretation of gas found at necropsy. Gas analyses have been proven to help differentiating putrefaction gases from gases formed after hyperbaric exposures. Unfortunately, chemical analysis cannot always be performed. Post-mortem computed tomography is used to study gas collections, but many different logistical obstacles and obvious challenges, like the size of the animal or the transport of the animal from the stranding location to the scanner, limit its use in stranded marine mammals. In this study, we tested the diagnostic value of an index-based method for characterizing the amount and topography of gas found grossly during necropsies. For this purpose, putrefaction gases, intravenously infused atmospheric air, and gases produced by decompression were evaluated at necropsy with increased post-mortem time in New Zealand White Rabbits using a gas score index. Statistical differences (P<0.001) were found between the three experimental models immediately after death. Differences in gas score between in vivo gas embolism and putrefaction gases were found significant (P<0.05) throughout the 67h post-mortem. The gas score-index is a new and simple method that can be used by all stranding networks, which has been shown through this study to be a valid diagnostic tool to distinguish between fatal decompression, iatrogenic air embolism and putrefaction gases at autopsies.
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Affiliation(s)
- Yara Bernaldo de Quirós
- Veterinary Histology and Pathology, Department of Morphology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
| | - Pedro Saavedra
- Department of Mathematics, University of Las Palmas de Gran Canaria (ULPGC), Campus de Tafira s/n, 35017, Las Palmas, Spain.
| | - Andreas Møllerløkken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Alf O Brubakk
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arve Jørgensen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Diagnostic Imaging, St. Olavs University Hospital, Trondheim, Norway.
| | - Oscar González-Díaz
- Physical and Chemical Instrumental Center for the Development of Applied Research Technology and Scientific estate, Edificio Polivalente 1, University of Las Palmas de Gran Canaria (ULPGC), Campus de Tafira s/n, 35017, Las Palmas, Spain.
| | - Jose L Martín-Barrasa
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario de Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain; Infectious Diseases and Fish Pathology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
| | - Antonio Fernández
- Veterinary Histology and Pathology, Department of Morphology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria (ULPGC), Trasmontaña s/n, 35416 Arucas, Las Palmas, Spain.
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Biljardt S, Brummel A, Tijhuis R, Sieswerda-hoogendoorn T, Beenen L, van Rijn R. Post-mortem fluid stasis in the sinus, trachea and mainstem bronchi; a computed tomography study in adults and children. ACTA ACUST UNITED AC 2015; 3:162-6. [DOI: 10.1016/j.jofri.2015.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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