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Neubauer J, Kissel CK, Bolliger SA, Barbon D, Thali MJ, Kloiber D, Bode PK, Kovacs B, Graf U, Maspoli A, Berger W, Saguner AM, Haas C. Benefits and outcomes of a new multidisciplinary approach for the management and financing of sudden unexplained death cases in a forensic setting in Switzerland. Forensic Sci Int 2022; 334:111240. [DOI: 10.1016/j.forsciint.2022.111240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
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Gascho D, Kottner S, Buehlmann A, Schweizer D, Bolliger SA, Thali MJ, Zoelch N. Annular distribution patterns of .357 Magnum fragments in soft tissue simulants after striking hard material that prevented the bullet from exiting. J Forensic Leg Med 2021; 85:102286. [PMID: 34844085 DOI: 10.1016/j.jflm.2021.102286] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
The distribution of bullet fragments inside the body can provide information for the reconstruction of events in shooting incidents. The formation of an annular distribution pattern of bullet fragments was recently presented in a case report. The fragments were scattered radially around an exit-re-entrance wound resulting from collision of the bullet with a floor tile immediately after perforating the body. Such an annular distribution pattern of bullet fragments around an exit-re-entrance wound would indicate that a body was in close contact with hard material, for instance, lying on hard ground or leaning against a concrete wall, when the shot was fired. The aim of this experimental study was to investigate the formation and reproducibility of the annular distribution pattern of bullet fragments. It was assumed that the distribution pattern would be formed when hard material blocks a bullet from exiting a soft tissue simulant. Furthermore, the dependency of this distribution pattern on the impact angle was assessed. For this purpose, .357 Magnum bullets were fired at ballistic soap blocks with a steel plate at the rear end of the soap block. Six shots were performed at an impact angle of 90° (experiment 1), and six shots were performed at an impact angle of 45° (experiment 2). The distribution pattern of the fragments inside the individual soap blocks was examined via computed tomography (CT). In experiment 1, the bullets burst, and large fragments formed annular distribution patterns with a radial extent of approximately 4.9 cm and a maximum depth of approximately 2.3 cm. In experiment 2, the bullets ricocheted from the steel plate, and tiny fragments formed small annular distribution patterns at the points of ricochet with a radial extent of approximately 1.5 cm and a maximum depth of approximately 1.2 cm. The end position of the large main fragments was approximately 9.7 cm distant from the point of ricochet at a mean depth of 2.7 cm. The mean kinetic energy of the bullets at the time of impact was 580 J in experiment 1 and 394 J in experiment 2. Distribution patterns of bullet fragments in the body may provide information not only on the impact angle of a bullet but also on whether the body was in contact with a hard material that blocked the bullet from exiting the body. CT proved to be an appropriate imaging method for such investigations.
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Affiliation(s)
- D Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland.
| | - S Kottner
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - A Buehlmann
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Switzerland
| | - D Schweizer
- Zurich Forensic Science Institute, Zurich Canton Police and Zurich City Police, Switzerland
| | - S A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - M J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - N Zoelch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
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Gascho D, Thali MJ, Martinez RM, Bolliger SA. Cinematic rendering of a burst sagittal suture caused by an occipito-frontal gunshot wound. Forensic Sci Med Pathol 2021; 17:726-729. [PMID: 34106424 PMCID: PMC8629876 DOI: 10.1007/s12024-021-00387-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/27/2022]
Abstract
The computed tomography (CT) scan of a 19-year-old man who died from an occipito-frontal gunshot wound presented an impressive radiating fracture line where the entire sagittal suture burst due to the high intracranial pressure that arose from a near-contact shot from a 9 mm bullet fired from a Glock 17 pistol. Photorealistic depictions of the radiating fracture lines along the cranial bones were created using three-dimensional reconstruction methods, such as the novel cinematic rendering technique that simulates the propagation and interaction of light when it passes through volumetric data. Since the brain had collapsed, depiction of soft tissue was insufficient on CT images. An additional magnetic resonance imaging (MRI) examination was performed, which enabled the diagnostic assessment of cerebral injuries.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Rosa M Martinez
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Schweitzer W, Verster J, Aldomar E, Ebert L, Bolliger SA, Thali MJ, Ampanozi G. Forensic volumetric visualization of gunshot residue in its anatomic context in forensic post mortem computed tomography: Development of transfer function preset. Forensic Imaging 2021. [DOI: 10.1016/j.fri.2021.200451] [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: 11/25/2022]
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Gascho D, Bolliger SA, Thali MJ. CT and MRI of a transcardiac gunshot wound with an annular distribution of bullet fragments surrounding an exit-re-entrance wound after the bullet burst from a floor tile upon exiting the lying body. J Forensic Leg Med 2020; 77:102087. [PMID: 33249345 DOI: 10.1016/j.jflm.2020.102087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/07/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 01/19/2023]
Abstract
This case report describes medicolegal examinations of a decedent with a fatal gunshot wound. The decedent lied on the floor as a bullet was fired into his chest. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed as part of the judicial investigation. The MRI examination was valuable for delineating the wound channel through the left ventricle, which was deemed the main cause for internal bleeding and fatal blood loss. The diagnostic value of CT for the detection of injuries was low in this case. However, CT allowed for the virtual investigation of bullet fragments. According to CT-based dual-energy index calculations, it could be inferred that the fragments were most likely made of lead matching .357 Magnum R-P cartridges that were found at the scene. The bullet fragments were located underneath the skin at the suspected exit wound. The exit wound was actually an exit-re-entrance wound, as it can be assumed that the fragments re-entered the body after the bullet burst from hard ground upon exiting the body of the decedent, who was lying on the floor. CT visualized an uncommon annular distribution pattern for the bullet fragments surrounding the exit-re-entrance wound. The formation of such an annular distribution pattern of bullet fragments and the relevant conclusions that may be drawn from such a distribution pattern are discussed in this article.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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Meixner E, Kallupurackal V, Kratzer A, Voegeli P, Thali MJ, Bolliger SA. Persistence and detection of touch DNA and blood stain DNA on pig skin exposed to water. Forensic Sci Med Pathol 2020; 16:243-251. [DOI: 10.1007/s12024-020-00234-3] [Citation(s) in RCA: 4] [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] [Accepted: 02/13/2020] [Indexed: 01/15/2023]
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Gascho D, Thali MJ, Bolliger SA. Hidden shot pellets on postmortem computed tomography and their utilization for radiologic identification of decedents. Forensic Sci Med Pathol 2019; 16:340-344. [DOI: 10.1007/s12024-019-00213-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 01/17/2023]
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Brockbals L, Staeheli SN, Gentile S, Schlaepfer M, Bissig C, Bolliger SA, Kraemer T, Steuer AE. Fatal poisoning involving cyclopropylfentanyl - Investigation of time-dependent postmortem redistribution. Forensic Sci Int 2018; 294:80-85. [PMID: 30497048 DOI: 10.1016/j.forsciint.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
A growing number of fatal overdoses involving opioid drugs, in particular involving fentanyl and its analogues, pose an immense threat to public health. Postmortem casework of forensic toxicologists in such cases is challenging, as data on pharmacodynamic and pharmacokinetic properties as well as reference values for acute toxicities and data on potential postmortem redistribution (PMR) mechanisms often do not exist. A fatal case involving cyclopropylfentanyl was investigated at the Zurich Institute of Forensic Medicine and the Zurich Forensic Science Institute; an unknown powder found at the scene was reliably identified as cyclopropylfentanyl by gas chromatography-infrared spectroscopy (GC-IR). Femoral blood samples were collected at two time points after death; 11h postmortem (t1) and during the medico-legal autopsy 29h after death (t2). At the autopsy, additional samples from the heart blood, urine and gastric content were collected. Cyclopropylfentanyl was quantified using a validated liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Femoral blood concentration of cyclopropylfentanyl at autopsy was 19.8ng/mL (t1=15.7ng/mL; heart blood concentration at autopsy=52.4ng/mL). In the light of the current literature and under the exclusion that no other morphological findings could explain the cause of death, contribution of cyclopropylfentanyl to death was proposed (polydrug use). Significant postmortem concentration increases of cyclopropylfentanyl in femoral blood during 18h after the first sampling were observed, thus indicating a relevant potential to undergo PMR. A central-to-peripheral blood concentration ratio of 2.6 supports this. Consequently, the current case suggests that postmortem cyclopropylfentanyl concentration should always be interpreted with care.
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Affiliation(s)
- Lana Brockbals
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Sandra N Staeheli
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Simon Gentile
- Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | | | | | - Stephan A Bolliger
- Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Andrea E Steuer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.
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Medeiros-Domingo A, Bolliger SA, Gräni C, Rieubland C, Hersch D, Asatryan B, Schyma C, Saguner AM, Wyler D, Bhuiyan Z, Fellmann F, Osculati AM, Ringger R, Fokstuen S, Sabatasso S, Wilhelm M, Michaud K, For the Swiss Working Group on Sudden Cardiac Death. Recommendations for genetic testing and counselling after sudden cardiac death: practical aspects for Swiss practice. Swiss Med Wkly 2018; 148:w14638. [DOI: 10.57187/smw.2018.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is a need to standardise, within a coordinated Swiss framework, the practical aspects of genetic testing and genetic counselling on possibly inherited cardiovascular disorders in relatives of a sudden cardiac death (SCD) victim. Because of the major advances in genetic investigation techniques and recent publication of international guidelines in the field of cardiology, genetics and pathology, we consider it important to summarise the current evidence and propose an optimal approach to post-mortem genetic investigation for SCD victims and their families in Switzerland. In this article, we discuss important technical, financial and medico-ethical aspects, and provide updated information on specific situations in which forensic pathologists, general practitioners and cardiologists should suspect a genetic origin of the SCD. At present, the principles of benefit, the duty to warn and the impact of genetic information for family members at risk are considered as strong justifications for post-mortem disclosure and prevail over the arguments of respect for a deceased person’s privacy and confidentiality. This paper underlines also the need to update and improve the general knowledge concerning the genetic risk of cardiovascular pathologies, the importance to perform an autopsy and post-mortem genetic testing in SCD victims, and to develop standardized post-mortem disclosure policy at national and international levels for SCD cases and relatives.
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Abstract
Suitcases or other containers are occasionally involved in forensic investigations. If there is a suspicion that human remains are hidden inside such a container, medico-legal examinations are required. However, these containers are occasionally locked. Forced opening of a locked suitcase or container may cause damage to its contents. Additionally, the safety of the investigator has to be considered as such containers may be booby-trapped or contain other hazardous material. An overview of the contents before opening is desirable in order to avoid the possibility of encountering a Pandora's box. In forensic medicine, an established approach to examine the inside of a body before opening at autopsy is postmortem computed tomography (CT). However, there may be a reluctance to use this approach for suitcases or containers with metallic components because of the assumption that severe metal artifacts will result in inadequate images. In this article, we present a forensic case in which a CT scan of a metallic suitcase was performed in order to examine its contents. Additionally, we performed an experimental scan of a conventional safe in order to determine if CT is able to reveal the contents of such a highly radiopaque storage box.
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Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Markus Enders
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Barbara Fliss
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
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Staeheli SN, Boxler MI, Oestreich A, Marti M, Gascho D, Bolliger SA, Kraemer T, Steuer AE. Postmortem distribution and redistribution of MDAI and 2-MAPB in blood and alternative matrices. Forensic Sci Int 2017; 279:83-87. [PMID: 28850871 DOI: 10.1016/j.forsciint.2017.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 05/22/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
Intoxication cases involving new psychoactive substances (NPS) provide several challenges for forensic toxicologists as data on pharmacodynamic and pharmacokinetic properties are lacking, especially on potency and toxicity. Furthermore, reference values and information on postmortem redistribution (PMR) do not exist so far for most NPS. A fatal case involving the amphetamine-derivatives MDAI (5,6-methylenedioxy-2-aminoindane) and 2-MAPB (1-(benzofuran-2-yl)-N-methylpropan-2-amine) was investigated at the Zurich Institute of Forensic Medicine. At admission at the institute approx. 11h after death (first time point, t1), femoral and heart blood (right ventricle) was collected using computed tomography (CT)-guided biopsy sampling. At autopsy (t2), samples from the same body regions as well as various tissue samples were collected manually. In addition, an antemortem blood sample collected 6h before death was available. MDAI and 2-MAPB were quantified using a validated LC-MS/MS method. A significant concentration decrease between the antemortem and the first peripheral postmortem blood sample was observed, which most probably can be explained by remaining metabolism and excretion within the last 6h prior to death. No significant concentration change was observed between the two postmortem heart blood and peripheral blood samples. Accordingly, MDAI and 2-MAPB did not seem to undergo relevant postmortem redistribution in peripheral and heart blood in the presented case. This is the first study on postmortem redistribution of the new psychoactive substances MDAI and 2-MAPB. However, more studies covering more cases are necessary to generate universal statements on the PMR with these two NPSs.
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Affiliation(s)
- Sandra N Staeheli
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Martina I Boxler
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Andrea Oestreich
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Michelle Marti
- Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Stephan A Bolliger
- Department of Forensic Medicine & Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Andrea E Steuer
- Department of Forensic Pharmacology & Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.
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Chatzaraki V, Bolliger SA, Thali MJ, Eggert S, Ruder TD. Unexpected brain finding in pre-autopsy postmortem CT. Forensic Sci Med Pathol 2017; 13:367-371. [DOI: 10.1007/s12024-017-9880-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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13
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Gascho D, Schaerli S, Thali MJ, Bolliger SA. Response to "regarding the sudden death of a juvenile with rare TdT-negative T-LBL/T-ALL, splenic rupture, and mediastinal mass". Forensic Sci Med Pathol 2017; 13:397-398. [PMID: 28405884 DOI: 10.1007/s12024-017-9865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
| | - Sarah Schaerli
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
| | - Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland
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Bolliger SA, Poschmann SA, Thali MJ, Eggert S. A fully synthetic lung model for wound-ballistic experiments-First results. Forensic Sci Int 2017; 275:254-259. [PMID: 28414984 DOI: 10.1016/j.forsciint.2017.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/14/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Today, synthetic models have all but replaced animal and corpse models in examining damage to soft-tissues and skeletal structures by ballistic trauma. As, however, non-solid organs such as the lungs, have not been able to be replaced by a fully synthetic model we attempted to create such a model. MATERIAL AND METHODS 20% ordnance gelatine was frothed with a household mixer and cooled to stable foam. Several of these foam blocks were then stuck together with liquid gelatine and placed between 10% gelatine blocks. As controls, we embedded pig lungs in gelatine and compared the wound channels seen in computed tomography created upon shooting with 9mm Luger. RESULTS The fully synthetic models displayed radiological and physical densities comparable to real lungs. The wound profile characteristics of the fully synthetic lung models were very similar to the semisynthetic swine-gelatine models regarding the permanent wound cavity. Furthermore, in both semi- and fully synthetic models we detected a ring surrounding the permanent wound channel, most likely representing the remnants of the temporary wound cavity. CONCLUSION Our results indicate that this fully synthetic lung model is a viable substitute for ballistic experiments on lungs. We believe that further research on the temporary wound channel in lungs is possible with this model in order to provide more insight into the effect of ballistic trauma to the lungs not seen otherwise.
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Affiliation(s)
- S A Bolliger
- Institute of Forensic Medicine, University of Zurich, Switzerland.
| | - S A Poschmann
- Institute of Forensic Medicine, University of Zurich, Switzerland
| | - M J Thali
- Institute of Forensic Medicine, University of Zurich, Switzerland
| | - S Eggert
- Institute of Forensic Medicine, University of Zurich, Switzerland
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Bolliger SA, Kneubuehl BP, Thali MJ, Eggert S, Siegenthaler L. Stabbing energy and force required for pocket-knives to pierce ribs. Forensic Sci Med Pathol 2016; 12:394-398. [DOI: 10.1007/s12024-016-9803-z] [Citation(s) in RCA: 8] [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] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
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Abstract
In order to create a three-dimensional (3D) documentation of findings which can be reassessed if necessary by other experts, the research project 'Virtopsy®' was launched in the late 1990s. This project combined autopsy results with forensic imaging in the form of computed tomography, magnetic resonance tomography and 3D surface scanning. The success of this project eventually succeeded in convincing the courts in Switzerland to accept these novel methods as evidence. As opposition towards autopsies has grown over the last decades, Virtopsy also strives to find and elaborate additional methods which can answer the main forensic questions without autopsy. These methods comprise post-mortem angiography for illustration of the vascular bed and image-guided tissue and fluid sampling for histological, toxicological and microbiological examinations. Based on the promising results, post-mortem imaging, especially with 3D surface scanning, has meanwhile also been applied to living victims of assault, who have suffered patterned injuries due to bites, blows with objects, etc. In our opinion, forensic imaging is an objective method which offers the possibility for a reassessment of the findings by other experts, even after burial or cremation of the corpse, or healing of the injuries in living victims, thus leading to a greater security in court.
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Affiliation(s)
- Stephan A Bolliger
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Wintherthurerstrasse 190/52, Zurich 8057, Switzerland
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Abstract
Wound ballistics examines the specific effect, namely the wound profile, of bullets on the body by firing at synthetic models made of ordnance gelatine, glycerin soap and synthetic bones, validated with real cases from (battlefield) surgery and forensic pathology. Wound profile refers to the penetration depth, the bullet deformation/ fragmentation, the diameter of the permanent and the temporary wound cavity. Knowing these features and the used ammunition a surgeon can rapidly assess the amount damage within a patient. The forensic pathologist can draw conclusions as to the used ammunition based on the wound profile. By measuring of the destructive capability of different ammunition types, wound ballistics lays the foundation for guidelines concerning the maximum effect of military ammunition.
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Affiliation(s)
| | | | - Michael J Thali
- 1 Institut für Rechtsmedizin, Campus Irchel, Universität Zürich
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Wilhelm M, Bolliger SA, Bartsch C, Fokstuen S, Gräni C, Martos V, Medeiros Domingo A, Osculati A, Rieubland C, Sabatasso S, Saguner AM, Schyma C, Tschui J, Wyler D, Bhuiyan ZA, Fellmann F, Michaud K. Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach. Swiss Med Wkly 2015; 145:w14129. [PMID: 26098688 DOI: 10.4414/smw.2015.14129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.
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Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, University Hospital Bern, Switzerland
| | - Stephan A Bolliger
- Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Christine Bartsch
- Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Siv Fokstuen
- Genetic Medicine, University Hospitals of Geneva, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, Switzerland
| | - Viktor Martos
- Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | | | - Antonio Osculati
- Service of Legal Medicine Canton Ticino Switzerland and University Center of Legal Medicine University of Insubria-Varese, Italy
| | - Claudine Rieubland
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Sara Sabatasso
- University Center of Legal Medicine Lausanne-Geneva, University Hospitals Geneva, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | | | - Joelle Tschui
- Institute of Forensic Medicine, University of Bern, Switzerland
| | - Daniel Wyler
- Institute of Pathology and Forensic Medicine, Kantonsspital Graubünden, Switzerland
| | - Zahurul A Bhuiyan
- Service of Medical Genetics, University Hospital of Lausanne, Switzerland
| | - Florence Fellmann
- Service of Medical Genetics, University Hospital of Lausanne, Switzerland
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne-Geneva, University Hospital Lausanne, Switzerland
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Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics 2015; 34:830-46. [PMID: 24819799 DOI: 10.1148/rg.343115169] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps in clinical (antemortem) radiology. Because there is no circulation in a corpse that could transport or dilute a contrast medium, the injection must be performed by using a roller pump to fill the vasculature (arterial and venous) with a mixture of a water-soluble iodized contrast medium and polyethylene glycol. In contrast to a classic autopsy, postmortem CT angiography is a minimally invasive procedure. It allows the diagnosis of vascular lesions without the disruption or destruction of anatomic structures, which could result in a loss of evidence in a criminal investigation. Furthermore, postmortem CT angiography facilitates the display of vascular pathologic conditions in areas that are not typically covered with autopsy alone, such as the craniocervical junction and the small pelvis. Therefore, postmortem CT angiography adds substantial value to the classic forensic autopsy; cross-sectional data can be reevaluated objectively at any time and are fully reproducible as counterexpertise, which is as useful in the fields of forensic medicine and pathology as in clinical research. Familiarity with the capabilities of postmortem CT angiography may help radiologists working with forensic cases improve their diagnostic performance.
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Affiliation(s)
- Steffen G Ross
- From the Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland (S.G.R., S.A.B., G.A., M.J.T., P.M.F.); the Institute of Forensic Medicine, University of Berne, Berne, Switzerland (S.G.R.); the Institute of Forensic Medicine, University of Berlin, Berlin, Germany (L.O.); and the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland (P.M.F.)
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Franckenberg S, Schulze C, Bolliger SA, Gascho D, Thali MJ, Flach PM. Postmortem angiography in computed tomography and magnetic resonance imaging in a case of fatal hemorrhage due to an arterio-venous malformation in the brain. Leg Med (Tokyo) 2014; 17:180-3. [PMID: 25572321 DOI: 10.1016/j.legalmed.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/21/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Autopsy is the traditional gold standard for determining the cause and manner of death in a forensic death investigation. However, postmortem imaging plays an ever-growing role in preliminary examination, even replacing conventional autopsy in some cases. This case report presents a case of massive intra-axial brain hemorrhage due to an arterio-venous malformation. The cause and manner of death were exclusively determined by postmortem radiology. Based on radiological findings, the autopsy was considered redundant and cancelled by the public prosecutor.
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Affiliation(s)
- Sabine Franckenberg
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
| | - Claudia Schulze
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Stephan A Bolliger
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Patricia M Flach
- Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
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Filograna L, Flach PM, Bolliger SA, Thali MJ. The role of post-mortem CT (PMCT) imaging in the diagnosis of pericardial tamponade due to hemopericardium: A case report. Leg Med (Tokyo) 2014; 16:150-3. [PMID: 24636310 DOI: 10.1016/j.legalmed.2014.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
Hemopericardium (HP) is frequently found at autopsy, but it represents a challenge for the forensic pathologist when having to assess its etiopathological relationship in causing death, particularly in those cases where ante-mortem clinical and instrumental data are not available. The diagnosis of pericardial tamponade (PT), in fact, is based on signs, symptoms and instrumental evidence and not only on the presence of HP. Post-mortem imaging techniques are actually considered a useful and non-invasive method able to enhance traditional procedures in demonstrating critical forensic findings; consequently, post-mortem imaging methods have been widely introduced in forensic investigations. We report a case of death clearly due to PT caused by ruptured dissected aneurysm of the aorta, submitted to post-mortem CT (PMCT) and PMCT angiography prior to autopsy. PMCT imaging permitted to solve the case without performing autopsy. In the paper we identify PMCT findings suggestive of PT with the aim of verifying the possibility to use post-mortem evidence to retrospectively demonstrate an in vivo dynamic clinical condition, such as PT.
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Affiliation(s)
- Laura Filograna
- Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
| | - Patricia M Flach
- Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Stephan A Bolliger
- Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, Forensic Imaging and Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
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Rüegger CM, Bartsch C, Martinez RM, Ross S, Bolliger SA, Koller B, Held L, Bruder E, Bode PK, Caduff R, Frey B, Schäffer L, Bucher HU. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial. BMC Pediatr 2014; 14:15. [PMID: 24438163 PMCID: PMC3897955 DOI: 10.1186/1471-2431-14-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population. Methods/Design Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard. Discussion There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures. Trial Registration ClinicalTrials.gov: NCT01888380
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Bolliger SA, Ruder TD, Ketterer T, Gläser N, Thali MJ, Ampanozi G. Comparison of stab wound probing versus radiological stab wound channel depiction with contrast medium. Forensic Sci Int 2013; 234:45-9. [PMID: 24378301 DOI: 10.1016/j.forsciint.2013.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 11/05/2012] [Revised: 09/03/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Instillation of contrast medium into stab wounds has shown promising results regarding visibility and assessment of general stab direction with computed tomography. However, the accuracy of this method--and, incidentally also probing of stab wounds--has to our knowledge not previously been examined. Also the effect of bluntness of different stabbing objects on the examination of stab wounds was not considered before this study. METHODS Using a pocket-knife, a steak-knife, and a Phillips screwdriver, nine stab wounds each were inflicted to three pork haunches. The depths of the stab wounds were determined by probing and multislice computed tomography (MSCT) after instillation of a contrast medium (CM) and then compared to those observed by dissection, our internal "gold standard". RESULTS In stab wounds inflicted by knives, MSCT-CM and probing provided results which differed by roughly 10-11% from the dissection results. In screwdriver stabs MSCT-CM showed a deviation of almost 30%, probing over 33%. DISCUSSION MSCT-CM is a possible alternative to layer-by-layer dissection in autopsy cases of knife stab wounds. Probing, although obsolete in post-mortem examinations, is sufficiently accurate in determining the length of a stab wound of a living person. In cases of stab wounds with blunt objects such as screwdrivers, neither MSCT-CM nor probing proved to be sufficiently accurate. CONCLUSION MSCT-CM is a possible alternative to layer-by-layer dissection in autopsy cases of knife stab wounds. Probing, although obsolete in post-mortem examinations, is sufficiently accurate in determining the length of a stab wound of a living person. In cases of stab wounds with blunt objects such as screwdrivers, neither MSCT-CM nor probing proved to be sufficiently accurate.
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Affiliation(s)
- Stephan A Bolliger
- Institute of Forensic Medicine, Department of Forensic Medicine, Cantonal Hospital, Aarau, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Switzerland.
| | - Thomas D Ruder
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Switzerland; Institute of Diagnostic, Interventional, and Paediatric Radiology, University Hospital Bern, Switzerland
| | - Thomas Ketterer
- Institute of Forensic Medicine, Department of Forensic Medicine, Cantonal Hospital, Aarau, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland
| | - Nadine Gläser
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Switzerland
| | - Garyfalia Ampanozi
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland; Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Switzerland
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Filograna L, Hatch G, Ruder T, Ross SG, Bolliger SA, Thali MJ. The role of post-mortem imaging in a case of sudden death due to ascending aorta aneurysm rupture. Forensic Sci Int 2013; 228:e76-80. [PMID: 23485035 DOI: 10.1016/j.forsciint.2013.01.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 06/13/2012] [Accepted: 01/27/2013] [Indexed: 11/28/2022]
Abstract
A 65-year-old man collapsed suddenly, while on an escalator. Despite intensive cardio-pulmonary resuscitation, the subject died 1h later. Post-mortem magnetic resonance imaging and post-mortem computed tomography angiography demonstrated rupture of an ascending aortic aneurysm, with haemorrhage into the pericardial cavity and the uncommon associated finding of haemorrhage into the left hemi-thorax through a small left-sided pericardial defect. The cause of death was thus attributed to the rupture of thoracic aortic aneurysm, and traditional autopsy was not performed. The circumstances of the case will be discussed, followed by a discussion of the imaging findings, mechanism of death, and explanation of the findings in this case. Finally, on the basis of this case report, we suggest that in selected cases, post-mortem imaging can be used as a screening tool for conducting hypotheses on the cause and mechanism of death before autopsy.
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Affiliation(s)
- Laura Filograna
- Institute of Forensic Medicine, Center of Forensic imaging and Virtopsy, University of Bern, Bühlstrasse 20, 3012 Bern, Switzerland.
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Ruder TD, Thali Y, Bolliger SA, Somaini-Mathier S, Thali MJ, Hatch GM, Schindera ST. Material differentiation in forensic radiology with single-source dual-energy computed tomography. Forensic Sci Med Pathol 2012; 9:163-9. [PMID: 23264199 DOI: 10.1007/s12024-012-9398-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/24/2022]
Abstract
The goal of this study was to investigate the use of dual-energy computed tomography (CT) in differentiating frequently encountered foreign material on CT images using a standard single-source CT scanner. We scanned 20 different, forensically relevant materials at two X-Ray energy levels (80 and 130 kVp) on CT. CT values were measured in each object at both energy levels. Intraclass correlation coefficient (ICC) was used to determine intra-reader reliability. Analysis of variance (ANOVA) was performed to assess significance levels between X-Ray attenuation at 80 and 130 kVp. T test was used to investigate significance levels between mean HU values of individual object pairings at single energy levels of 80 and 130 kVp, respectively. ANOVA revealed that the difference in attenuation between beam energies of 80 kVp compared to 130 kVp was statistically significant (p < 0.005) for all materials except brass and lead. ICC was excellent at 80 kVp (0.999, p < 0.001) and at 130 kVp (0.998, p < 0.001). T test showed that using single energy levels of 80 and 130 kVp respectively 181/190 objects pairs could be differentiated from one another based on HU measurements. Using the combined information from both energy levels, 189/190 object pairs could be differentiated. Scanning with different energy levels is a simple way to apply dual-energy technique on a regular single-energy CT and improves the ability to differentiate foreign bodies with CT, based on their attenuation values.
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Affiliation(s)
- Thomas D Ruder
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
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Bolliger SA, Ross S, Thali MJ, Hostettler B, Menkveld-Gfeller U. Scenes from the Past: Initial Investigation of Early Jurassic Vertebrate Fossils with Multidetector CT. Radiographics 2012; 32:1553-9. [DOI: 10.1148/rg.325115742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Flach PM, Ross SG, Bolliger SA, Ampanozi G, Hatch GM, Schön C, Thali MJ, Germerott T. Massive systemic fat embolism detected by postmortem imaging and biopsy. J Forensic Sci 2012; 57:1376-80. [PMID: 22537470 DOI: 10.1111/j.1556-4029.2012.02144.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image-guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image-guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image-guided biopsy, may detect the cause of death prior to traditional autopsy.
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Affiliation(s)
- Patricia M Flach
- Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
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Filograna L, Bolliger SA, Kneubuehl B, Jackowski C, Hatch GM, Thali MJ. A minimally invasive technique for the detection and analysis of pulmonary fat embolism: a feasibility study. J Forensic Sci 2012; 57:1329-35. [PMID: 22509792 DOI: 10.1111/j.1556-4029.2012.02134.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated the feasibility of postmortem percutaneous needle biopsy (PNB) for obtaining pulmonary samples adequate for the study of pulmonary fat embolism (PFE). Samples of both lungs were obtained from 26 cadavers via two different methods: (i) PNB and (ii) the double-edged knife technique, the gold standard at our institute. After water storage and Sudan III staining, six forensic pathologists independently examined all samples for the presence and severity of PFE. The results were compared and analyzed in each case regarding the vitality of the PFE and its relationship to the cause of death. The results showed that PFE was almost identically diagnosed and graded on the samples obtained via both methods. The discrepancies between the two techniques did not affect the diagnoses of vitality or cause of death related to PFE. This study demonstrates the feasibility of the PNB sampling method for the diagnosis and interpretation of PFE in the postmortem setting.
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Affiliation(s)
- Laura Filograna
- Department of Legal Medicine, Centre of Forensic Imaging and Virtopsy, University of Berne, Bern, Switzerland.
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Thali YA, Bolliger SA, Hatch GM, Ampanozi G, Thali MJ, Ruder TD. Death by biscuit--exhumation, post-mortem CT, and revision of the cause of death one year after interment. Leg Med (Tokyo) 2011; 13:142-4. [PMID: 21269860 DOI: 10.1016/j.legalmed.2010.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
We describe a case of exhumation, performed to investigate the circumstances and cause of death, one year after burial. Post mortem computed tomography (PMCT) revealed a mass in the pharynx. Imaging directed the subsequent forensic autopsy to careful retrieval of a foreign body. Histological analysis revealed a non-cellular composition. The detection of foreign material in the pharynx and its composition indicated accidental, rather than natural death, secondary to choking on food. This unusual case illustrates how post mortem imaging can significantly contribute to forensic investigation and stresses the importance of interdisciplinary collaboration between forensic pathologists and radiologists.
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Affiliation(s)
- Yannick A Thali
- Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
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Gläser N, Kneubuehl BP, Zuber S, Axmann S, Ketterer T, Thali MJ, Bolliger SA. Biomechanical Examination of Blunt Trauma due to Baseball Bat Blows to the Head. ACTA ACUST UNITED AC 2011. [DOI: 10.4303/jfb/f100601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berens S, Ketterer T, Kneubuehl BP, Thali MJ, Ross S, Bolliger SA. A case of homicidal intraoral gunshot and review of the literature. Forensic Sci Med Pathol 2010; 7:209-12. [DOI: 10.1007/s12024-010-9201-x] [Citation(s) in RCA: 14] [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] [Accepted: 10/21/2010] [Indexed: 11/28/2022]
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Filograna L, Bolliger SA, Spendlove D, Schön C, Flach PM, Thali MJ. Diagnosis of fatal pulmonary fat embolism with minimally invasive virtual autopsy and post-mortem biopsy. Leg Med (Tokyo) 2010; 12:233-7. [PMID: 20494605 DOI: 10.1016/j.legalmed.2010.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/06/2010] [Accepted: 04/15/2010] [Indexed: 11/28/2022]
Abstract
We report a case of a 78-year-old female with a proximal femur fracture caused by an accidental fall who died suddenly 1h after orthopaedic prosthesis insertion. Post-mortem computed tomography (CT) scan and histological examination of samples obtained with post-mortem percutaneous needle biopsies of both lungs were performed. Analysis of the medical history and the clinical scenario immediately before death, imaging data, and biopsy histology established the cause of death without proceeding to traditional autopsy. It was determined to be acute right ventricular failure caused by massive pulmonary fat embolism. Although further research in post-mortem imaging and post-mortem tissue sampling by needle biopsies is necessary, we conclude that the use of CT techniques and percutaneous biopsy, as additional tools, can offer a viable alternative to traditional autopsy in selected cases and may increase the number of minimally invasive forensic examinations performed in the future.
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Affiliation(s)
- Laura Filograna
- Department of Legal Medicine, Centre of Forensic Imaging and Virtopsy, University of Berne, Buehlstrasse 20, 3012 Bern, Switzerland.
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Flach PM, Ross SG, Bolliger SA, Preiss US, Thali MJ, Spendlove D. Postmortem whole-body computed tomography angiography visualizing vascular rupture in a case of fatal car crash. Arch Pathol Lab Med 2010; 134:115-9. [PMID: 20073614 DOI: 10.5858/2008-0503-crr3.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In addition to the increasingly significant role of multislice computed tomography in forensic pathology, the performance of whole-body computed tomography angiography provides outstanding results. In this case, we were able to detect multiple injuries of the parenchymal organs in the upper abdomen as well as lesions of the brain parenchyma and vasculature of the neck. The radiologic findings showed complete concordance with the autopsy and even supplemented the autopsy findings in areas that are difficult to access via a manual dissection (such as the vasculature of the neck). This case shows how minimally invasive computed tomography angiography can serve as an invaluable adjunct to the classic autopsy procedure.
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Affiliation(s)
- Patricia M Flach
- Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
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Spendlove D, Bolliger SA. [A dead man with a light reddish skin]. Ned Tijdschr Geneeskd 2010; 154:B329. [PMID: 20298627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 40-year-old man was found dead in his bathroom with a light reddish skin. The cause of death was asphyxia due to CO-intoxication.
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Affiliation(s)
- Danny Spendlove
- Universiteit Bern, Instituut voor forensische geneeskunde, Centrum forensische beeldgeving, Bern.
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Bolliger SA, Oesterhelweg L, Spendlove D, Ross S, Thali MJ. Is Differentiation of Frequently Encountered Foreign Bodies in Corpses Possible by Hounsfield Density Measurement? J Forensic Sci 2009; 54:1119-22. [DOI: 10.1111/j.1556-4029.2009.01100.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oesterhelweg L, Bolliger SA, Thali MJ, Ross S. Virtopsy: Postmortem Imaging of Laryngeal Foreign Bodies. Arch Pathol Lab Med 2009; 133:806-10. [DOI: 10.5858/133.5.806] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Death from corpora aliena in the larynx is a well-known entity in forensic pathology. The correct diagnosis of this cause of death is difficult without an autopsy, and misdiagnoses by external examination alone are common.
Objective.—To determine the postmortem usefulness of modern imaging techniques in the diagnosis of foreign bodies in the larynx, multislice computed tomography, magnetic resonance imaging, and postmortem full-body computed tomography–angiography were performed.
Design.—Three decedents with a suspected foreign body in the larynx underwent the 3 different imaging techniques before medicolegal autopsy.
Results.—Multislice computed tomography has a high diagnostic value in the noninvasive localization of a foreign body and abnormalities in the larynx. The differentiation between neoplasm or soft foreign bodies (eg, food) is possible, but difficult, by unenhanced multislice computed tomography. By magnetic resonance imaging, the discrimination of the soft tissue structures and soft foreign bodies is much easier. In addition to the postmortem multislice computed tomography, the combination with postmortem angiography will increase the diagnostic value.
Conclusions.—Postmortem, cross-sectional imaging methods are highly valuable procedures for the noninvasive detection of corpora aliena in the larynx.
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Affiliation(s)
- Lars Oesterhelweg
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Stephan A. Bolliger
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Michael J. Thali
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Steffen Ross
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
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Andenmatten MA, Thali MJ, Kneubuehl BP, Oesterhelweg L, Ross S, Spendlove D, Bolliger SA. Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 2008; 10:287-92. [PMID: 18485787 DOI: 10.1016/j.legalmed.2008.03.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 10/22/2022]
Abstract
Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies or even replace them altogether in the future. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in fatal gunshot injuries, 22 corpses underwent such an examination prior to forensic autopsy. The cardinal questions of the location of entrance and exit wounds, the detection of bullets and bullet fragments in the body, the bullet course, inflicted injuries and cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT can answer these questions reliably and is therefore a useful tool in the assessment of such injuries.
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Affiliation(s)
- M A Andenmatten
- Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, IRM, Buehlstrasse 20, CH3012 Bern, Switzerland
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Abstract
An outwardly mummified and inwardly badly decomposed body was found in a garage. At autopsy, no injuries were detected. Apart from coronary heart disease, with an old myocardial scar and a hepatic steatosis, the most striking finding was a large intracranial epidural hemorrhage situated at the left frontal lobe. As a relevant traumatic genesis could be ruled out, we deemed this a nontraumatic epidural hematoma. This finding is extremely rare. Several underlying disorders have been discussed as causes of spontaneous epidural hematomas. In this presented case, the authors discuss possible etiological factors.
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Oesterhelweg L, Ross S, Spendlove D, Schoen CA, Christe A, Thali MJ, Bolliger SA. Virtopsy: Fatal stab wounds to the skull – The relevance of ante-mortem and post-mortem radiological data in case reconstructions. Leg Med (Tokyo) 2007; 9:314-7. [PMID: 17567525 DOI: 10.1016/j.legalmed.2007.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 04/10/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
Homicides with a survival of several days are not uncommon in forensic routine work. Reconstructions of these cases by autopsy alone are very difficult and may occasionally lead to unsatisfying results. For the medico-legal reconstruction of these cases, ante-mortem and post-mortem radiological imaging should always be included in the expertise. We report on a case of fatal penetrating stab wounds to the skull in which a case reconstruction was only possible by combining the radiological ante- and post-mortem data with the autopsy findings.
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Affiliation(s)
- L Oesterhelweg
- Center Forensic Imaging and Virtopsy at the University of Bern, Institute of Forensic Medicine, Bern, Switzerland.
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Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P. Virtual autopsy using imaging: bridging radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol 2007; 18:273-82. [PMID: 17705044 DOI: 10.1007/s00330-007-0737-4] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 06/25/2007] [Accepted: 07/16/2007] [Indexed: 11/28/2022]
Abstract
The transdisciplinary research project Virtopsy is dedicated to implementing modern imaging techniques into forensic medicine and pathology in order to augment current examination techniques or even to offer alternative methods. Our project relies on three pillars: three-dimensional (3D) surface scanning for the documentation of body surfaces, and both multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) to visualise the internal body. Three-dimensional surface scanning has delivered remarkable results in the past in the 3D documentation of patterned injuries and of objects of forensic interest as well as whole crime scenes. Imaging of the interior of corpses is performed using MSCT and/or MRI. MRI, in addition, is also well suited to the examination of surviving victims of assault, especially choking, and helps visualise internal injuries not seen at external examination of the victim. Apart from the accuracy and three-dimensionality that conventional documentations lack, these techniques allow for the re-examination of the corpse and the crime scene even decades later, after burial of the corpse and liberation of the crime scene. We believe that this virtual, non-invasive or minimally invasive approach will improve forensic medicine in the near future.
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Affiliation(s)
- Stephan A Bolliger
- Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
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Abstract
A 19-year-old man speeding recklessly along a highway caused a left-frontal crash with another car. After his vehicle came to a standstill, he climbed out of the wreck and crawled across the tarmac to the other side of the road, where he died several minutes after the accident and before the arrival of an ambulance. Postmortem multislice computed tomography (MSCT) demonstrated fractures of the first, second, and third ribs and scapula on the left, an extrapleural hemorrhage in the apical region of the left thorax, as well as a large amount of blood in the left thoracic cavity. These radiologic findings were indicative of a delayed rupture of a traumatic extrapleural hematoma into the pleural space. A traditional autopsy confirmed the very rare diagnosis of a traumatic extrapleural hemorrhage with a delayed rupture.
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Pfaeffli M, Vock P, Dirnhofer R, Braun M, Bolliger SA, Thali MJ. Post-mortem radiological CT identification based on classical ante-mortem X-ray examinations. Forensic Sci Int 2006; 171:111-7. [PMID: 17141439 DOI: 10.1016/j.forsciint.2006.10.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 08/22/2006] [Accepted: 10/20/2006] [Indexed: 10/23/2022]
Abstract
Radiological identification is important in forensic medicine. Identification using comparison of individualising structures with ante- and post-mortem conventional radiographs has been known for a long time. New radiological procedures such as computed tomography (CT) and magnetic resonance imaging (MRI) are being increasingly used for identification. In this paper, a new comparative approach using various radiological methods is described and its application demonstrated. This new approach is the comparison of ante-mortem conventional radiographs with projected images calculated from post-mortem CT data. The identification procedure will be illustrated with reference to the frontal sinus and the pelvis.
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Affiliation(s)
- Matthias Pfaeffli
- Institute of Forensic Medicine, University of Berne, IRM, Buehlstrasse 20, CH-3012 Berne, Switzerland
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Thali MJ, Kneubuehl BP, Bolliger SA, Christe A, Koenigsdorfer U, Ozdoba C, Spielvogel E, Dirnhofer R. Forensic veterinary radiology: ballistic-radiological 3D computertomographic reconstruction of an illegal lynx shooting in Switzerland. Forensic Sci Int 2006; 171:63-6. [PMID: 16831528 DOI: 10.1016/j.forsciint.2006.05.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Revised: 03/21/2006] [Accepted: 05/22/2006] [Indexed: 11/28/2022]
Abstract
The lynx, which was reintroduced to Switzerland after being exterminated at the beginning of the 20th century, is protected by Swiss law. However, poaching occurs from time to time, which makes criminal investigations necessary. In the presented case, an illegally shot lynx was examined by conventional plane radiography and three-dimensional multislice computertomography (3D MSCT), of which the latter yielded superior results with respect to documentation and reconstruction of the inflicted gunshot wounds. We believe that 3D MSCT, already described in human forensic-pathological cases, is also a suitable and promising new technique for veterinary pathology.
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Affiliation(s)
- Michael J Thali
- Institute of Forensic Medicine, University of Berne, IRM, Buehlstrasse 20, CH-3012 Berne, Switzerland.
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