Postmortem Radiology and Imaging

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Postmortem Radiology and Imaging

Author: Angela D Levy, MD, Professor of Radiology, Georgetown University School of

Medicine

Contributor Information and Disclosures

Updated: Apr 28, 2010

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Introduction

Conventional radiography is traditionally used to complement forensic autopsy, serving primarily to document metallic bullet fragments, foreign bodies, fractures, and injury patterns. It

is also used to aid in the determination of identity when conventional methods of identificationsuch as fingerprinting or DNA analysis are not available or cannot be utilized.

1

The addition of cross-sectional imaging to forensic autopsy allows the radiologist and forensic

pathologist to view postmortem anatomy in 2 and 3 dimensions without dissection. Multidetector computed tomography (MDCT) scanning and magnetic resonance imaging (MRI) can be used to

focus the autopsy on specific abnormalities, view injury patterns in 3 dimensions, detect occultdisease or injury without dissection, and evaluate anatomic areas that are difficult to dissect.

In certain causes of death and forensic scenarios, cross-sectional imaging may be used to help

the forensic pathologists decide which decedents should have an autopsy or to determine whether the autopsy should be limited or complete. In those cases that do not undergo autopsy, cross-

sectional imaging findings add anatomic information to the external examination, toxicology,

and biochemical findings that may have been previously used alone to determine the cause of

death.

The purpose of this chapter is to discuss postmortem imaging techniques and the benefits and

limitations of postmortem radiography and cross-sectional imaging in specific causes of death.

Techniques in Postmortem Radiology and Imaging

Radiography

Conventional radiography is the most widely used postmortem radiology technique. It is used

most often to locate bullet fragments and to find projectiles and foreign bodies. In child abuse and anthropologic cases, radiography is the imaging modality of choice to evaluate subtle bone

detail.

Postmortem radiographic protocols should be standardized. Optimally, full-body radiography

with a single anterior-posterior (AP) view should be performed --even when the suspected

wound is in one anatomic location -- because additional injury or unsuspected pathology may be



found. This is especially true in gunshot wound cases, because bullets often travel to unexpected

locations in the body. Lateral views can be added to the protocol to localize abnormalities in 3

dimensions as needed. Standard conventions for labeling of radiographs with identifying

numbers or names and right- or left-sided body markers are necessary to avoid error.

C-arm fluoroscopy

C-arm fluoroscopy may be used to facilitate the localization and recovery of metallic fragmentsor foreign bodies at autopsy when they are not readily retrievable at dissection based upon thelocalization of the object on radiographs. It may also be used for limited angiographic

assessment of vascular integrity by directly injecting the vessel of concern with iodinated

contrast material under fluoroscopic observation. Radiation safety and protection measures

should be strictly followed for all personnel in the vicinity of an operating C-arm unit.

Multidetector computed tomography (MDCT) scanning

MDCT scanning, also known as multislice computed tomography (MSCT) scanning, is emerging

as the foremost cross-sectional imaging modality in forensic medicine. Its speed, ease of use, and

compatibility with metallic fragments make it an excellent complement to autopsy. The cost and

availability of MDCT scanners and personnel is the most important limitation in integratingcross-sectional imaging with autopsy. As an alternative to an on-site scanner, forensic facilities

may choose to collaborate with local radiology practices or hospitals in order to obtain MDCT

studies on specific cases.

MDCT scanners use a 2-dimensional (2-D) array of detector elements that improve resolution

and scan time when compared to older CT scanners. The alignment of the detectors along the

long (z-axis) of the body enables the scanners to obtain 4, 8, 16, 64, 128, or more slices with

each rotation of the x-ray tube. Protocols that specify the technical and anatomic parameters for

obtaining scan data, reconstructing scan data into images, and reformatting images into anatomic

planes may be organized for specific anatomic regions of the body similar to clinical scanning

protocols, or they can be more generalized to obtain full-body data.

A full-body scan on a 16-detector MDCT scanner acquires scan data from the skull vertex to a

distal point allowable by table travel (up to 2000 mm). No contrast material is administered.Scanning parameters that produce an isotropic 3-dimensional (3-D) data set enables multiplanar

reformations of images that have the same spatial resolution as the original sections withoutdegradation of image quality. Dedicated head scans are useful additions to the full-body protocol

to optimize the detection of intracranial pathology.

Angiography and MDCT angiography

A variety of postmortem angiography techniques have been reported to assess vascular injury

and disease.

2,3

The contrast agent, delivery mechanism, and injection technique can be altered based upon the location of the suspected abnormality and radiologic technique used to image

during contrast injection. Angiography may be performed with radiography, C-arm fluoroscopy,

or MDCT scanning.

Magnetic resonance imaging (MRI)

Postmortem MRI has been used to assess soft-tissue and visceral hemorrhage, ischemia, and

tumors.4,5,6

Although the technical complexity, expense, and availability of MRI make it morecomplicated to use as a routine imaging modality compared to MDCT, it provides superior



contrast resolution relative to MDCT, making it a more optimal imaging modality to visualize

soft tissues. Caution should be taken when imaging bodies that contain metal, because

ferromagnetic substances may pose potential harm or cause significant image degradation when

placed in the magnetic field of the scanner.

Role of Postmortem Radiology and Imaging in Specific

Causes of DeathBlunt trauma

Blunt force injury is the most common form of lethal and nonlethal trauma. Postmortem MDCT

scanning is useful to visualize and reconstruct blunt injury patterns before autopsy and the 3-

dimensional MDCT display of head, spine, and pelvic injuries may facilitate the understanding

of the mechanism of injury.7

In closed head trauma, cerebral contusions occurring on the gyral crests appear as focal punctate

or linear areas of hyperattenuating hemorrhage. Low attenuation edema may be located adjacent

to contusions. E pidural hematomas are typically biconvex in shape and have mass effect on the

adjacent brain. Subdural hematomas are crescent-shaped and do not cross dural attachments, asshown in the image below.

Axial multidetector computed tomography (MDCT) scan of the brain from a motor vehicle

accident victim who died from multisystem blunt trauma. This axial MDCT scan shows a

hyperattenuating acute right subdural hematoma (arrow). There is diffuse edema of the

right cerebral hemisphere, compression of the ventricular system, and subfalcine

herniation.

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herniation.

Acute epidural and subdural hematomas are classically hyperattenuating on MDCT scans, but

there may be mixed attenuation if multiple bleeding episodes occurred before death or if there is

decomposition. Chronic subdural hematomas typically demonstrate fluid attenuation on MDCTscans, because they are composed of serosanguineous fluid. Small subdural hematomas that are

thinly layered beneath the dura may be difficult to appreciate.

Diffuse axonal injury is a difficult diagnosis to make on MDCT scanning. The brain oftenappears normal, but it may show petechial hemorrhages in the corpus callosum and at the gray-

white junction. Subarachnoid hemorrhage is present in most cases of moderate to severe headtrauma. It is seen as a thin layer of high attenuation in the cerebrospinal fluid (CSF) spaces,

cisterns, and sulci on MDCT scans, as depicted in the following image.


accident victim who died from multisystem blunt trauma. This axial MDCT scan shows

subarachnoid hemorrhage adjacent to the cerebellar vermis (arrow). A small amount of intraventricular hemorrhage is also present. The intracranial gas and loss of gray and

white matter differentiation is due to decomposition.

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accident victim who died from multisystem blunt trauma. This axial MDCT scan shows



subarachnoid hemorrhage adjacent to the cerebellar vermis (arrow). A small amount of

intraventricular hemorrhage is also present. The intracranial gas and loss of gray and


Decomposition makes the diagnosis of subarachnoid hemorrhage more challenging, because the

dura adjacent to the brain appears relatively dense as decomposition begins to occur, and blood

decreases in attenuation as it decomposes.

Radiography or MDCT scanning in cases of blunt chest trauma is useful before autopsy to show

pneumothorax, tension pneumothorax, and pneumomediastinum, which may go undetected

during routine dissection. Pulmonary contusions are characterized by consolidation and

opacification in a nonsegmental distribution, associated with the site of impact. Consolidation in

the contralateral portion of the chest is indicative of a contrecoup contusion.

Pulmonary lacerations may appear as focal consolidations or cavities on MDCT scans. Linear

tracks of gas through the lung may also indicate communication with a bronchus and an

associated tracheal or bronchial laceration. Hemorrhage in the mediastinum is indicative of a

major vascular injury. Radiography may show widening of the mediastinum from a periaortic

hematoma, blurring of the aortic contour, or thickening of the paratracheal stripe.

On MDCT scans, aortic lacerations are characterized by alteration in the position and contour of

the aorta. MDCT angiography is potentially useful to identify the site of rupture. Injuries to theaortic arch branches, pulmonary artery, and vena cava may also produce mediastinal hematomas.

The location of hemorrhage may help establish the site of vascular injury. Diaphragm elevationshould raise concern for diaphragm laceration or rupture. Intraabdominal organs may protrude

into the thorax when there is laceration or rupture of the hemidiaphragm.

Diagnosis and interpretation of spine, pelvic, and extremity fractures is easily established withradiography and MDCT scanning. Fractures are linear, angulated, or displaced lucencies within

bone, as demonstrated in the following 2 images.



depressed skull fracture of the right parietal temporal region (arrow) and fracture of the

left frontal sinus with overlying soft -tissue defect. The brain has retracted from

decomposition, and there is decompositional gas within the cranium.

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Three-dimensional multidetector computed tomography (MDCT) scan of the head from a

motor vehicle accident victim who died from multisystem blunt trauma. This MDCT scan

shows the right-sided depressed skull fracture (arrow) and a left frontal fracture thatextends to the orbit (arrowhead ). There is streak artifact from dental restoration.

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shows the right-sided depressed skull fracture (arrow) and a left frontal fracture that

extends to the orbit (arrowhead ). There is streak artifact from dental restoration.

The margins of acute fractures are well defined and lack sclerosis. In the skull, they may cross

sutures and vascular impressions. Vertebral body compression fractures are characterized by loss

of vertebral body height and/or increased density within the bone from the compressive forces.

Vertebral body compression fractures and abnormalities in alignment are best viewed on sagittalMDCT images. Axial images are useful to view the pedicles and posterior elements of the

vertebral bodies. Three-dimensional images provide an excellent depiction of the anatomic

distribution of spine and pelvic fractures, which can be difficult to appreciate at autopsy.

Gunshot wounds

Gunshot wounds are exquisitely depicted on postmortem MDCT images. Gunshot wound tracks

are typically linear tissue defects containing gas and metallic fragments (see the 3 images

below).8

Frontal radiograph of the chest from a victim of a gunshot wound to the chest. This image

shows metallic bullet fragments overlying the heart and right lower chest. There are rightposterior rib fractures and a bilateral pneumothoraces.

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shows metallic bullet fragments overlying the heart and right lower chest. There are right

posterior rib fractures and a bilateral pneumothoraces.

Coronal multidetector computed tomography (MDCT) scan of the chest from a victim of a

gunshot wound to the chest. This image shows a gas -filled gunshot wound track that

extends from the left upper lobe (arrow) to the right lower lobe. Metallic bullet fragmentsare located in the right lower lung and adjacent to the right hemidiaphragm. The increased

density surrounding the gunshot wound track is hemorrhage.

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extends from the left upper lobe (arrow) to the right lower lobe. Metallic bullet fragments

are located in the right lower lung and adjacent to the right hemidiaphragm. The increased




extends from the left upper lobe to the right lower lobe. Metallic bullet fragments arelocated in the right lower lung and adjacent to the right hemidiaphragm. The increased


[ CLOSE WINDOW ]





extends from the left upper lobe to the right lower lobe. Metallic bullet fragments are

located in the right lower lung and adjacent to the right hemidiaphragm. The increased


If the bullet passes through bone, bone fragments may also be present along the track. In the

lungs, the finding of hemorrhage and cystic spaces characterize the bullet path. Gunshot wounds

through the brain are characterized by hemorrhage, foci of gas, metallic fragments, and bone. Insome cases, a distinct linear track within the brain is not identifiable. Metallic fragment analysis

and the pattern of fragment deposition along the gunshot wound track are excellently depicted on

2-dimensional multiplanar and 3-dimensional images that have thresholds adjusted for metal

attenuation. The various components of a bullet can be differentiated on CT scans, whichfacilitates recovery of the fragments for ballistic analysis.

The evaluation of skin-surface characteristics with MDCT scanning is limited. Three-

dimensional MDCT algorithms can depict the entry and exit wounds, but skin-surface featuressuch as wound shape, pigmentation, discoloration, and soot deposition are findings that can only

be made on external examination of the body. (Gunshot wounds will be discussed in more detailin a separate article.)

Natural deaths

Postmortem MDCT scanning is the most appropriate initial cross-sectional imaging technique insuspected natural deaths, because it provides a rapid anatomic survey of the head and body.

Postmortem MDCT scans provide supportive information and excludes occult trauma whenatherosclerotic coronary artery disease is the cause of death. The most common postmortem

MDCT findings in death from myocardial infarction from atherosclerotic coronary artery diseaseare coronary artery calcification and pulmonary edema. The degree of luminal narrowing or the

presence of arterial occlusion can only be assessed when contrast material is injected into thearterial system during MDCT imaging. MRI may be used to assess the myocardium.6,9

Deaths from aortic aneurysm rupture cause massive hemorrhage that may surround the aorta

and/or extend into the mediastinum, pericardium, or pleural spaces. In this setting, high

attenuation hemorrhage will be present on MDCT images. Aneurysmal dilatation of the aortamay or may not be apparent on MDCT scans, because if residual intravascular blood volume is

low, the aorta may be collapsed on postmortem imaging. The postmortem MDCT findings inaortic dissection are deformity of the aortic contour, intramural hematoma, hemopericardium,

and pulmonary edema. Hemopericardium, characterized by a hyperdense inner ring andhypodense outer ring is the most common MDCT finding in deaths from aortic dissection.

10

Angiography is required to confidently identify the intimal flap and false lumen of the dissectionwhen establishing the diagnosis by imaging alone.

In death from intracranial hemorrhage, acute blood is seen as high attenuation (80 to 90Hounsfield units [HU]) on MDCT scans. If the decedent survives beyond the acute stage of

hemorrhage, the hemorrhage will have lower attenuation on MDCT images. Intraparenchymal

hemorrhage is surrounded by vasogenic cerebral edema, which reaches its maximum at 4 to 5

days. The margins of intraparenchymal hemorrhage become less distinct over time.

Diffuse subarachnoid hemorrhage is characterized by high attenuation throughout the

subarachnoid spaces that interdigitate between the cerebral gyri and in the basilar cisterns.

Cerebral aneurysms are the most common cause of subarachnoid hemorrhage. The predominant

location of subarachnoid hemorrhage on MDCT scans may be a clue to the location of the



aneurysm, because the aneurysm may not be identified directly on routine postmortem MDCT

images. Postmortem angiography has the potential of demonstrating the aneurysm and site of

rupture.

If epilepsy is the cause of sudden death, the brain is often normal on MDCT scans. The role of

postmortem imaging in these deaths is to exclude intracranial pathology that may be a seizure

focus such as occult trauma, hemorrhage, or tumor, and to exclude other causes of death. Tumors

and cerebral infarctions are most often viewed as low attenuation on noncontrast postmortemMDCT images. They may exhibit mass effect from vasogenic edema, and evidence of cerebral

herniation may be present.

Burns

Postmortem MDCT scanning is useful in severely burned and charred bodies that are difficult to

examine. It may help identify antemortem traumatic injury and aid in localizing tissue suitable

for DNA analysis.11

Partial-thickness burns may produce no significant changes in the dermis or

mild irregularity of the dermis on MDCT images (see the following 2 images).

Axial multidetector computed tomography (MDCT) scan from an aviation accident victim

who died from blunt trauma before the fire of the crash. This image of the lower face andneck shows a complex cervical spine fracture dislocation with transection of the cervical

cord. Mandibular fractures are also present. Note the presence of full-thickness burns by

the irregular contour of the subcutaneous fat and focal areas of thermal tissue loss

(arrowheads).

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who died from blunt trauma before the fire of the crash. This image of the lower face and



neck shows a complex cervical spine fracture dislocation with transection of the cervical



(arrowheads).

Coronal multidetector computed tomography (MDCT) scan from an aviation accident

victim who died from blunt trauma before the fire of the crash. This maximum intensityprojection image shows a complex fracture of the sacrum, pelvis, and right femur.

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victim who died from blunt trauma before the fire of the crash. This maximum intensity

projection image shows a complex fracture of the sacrum, pelvis, and right femur.

Full-thickness burns show loss of the dermal layer with exposure of the underlying fat and/or

skeletal muscle that is typically irregular and jagged. In severely charred victims, skeletal muscle

is exposed and retracted from shortening and thermal destruction of muscle, as seen in the image below.

12

Coronal multidetector computed tomography (MDCT) scan of full-thickness burns and

thermal amputation in a motor vehicle crash victim. This image of the abdomen and lower

extremities shows thermal tissue loss with full-thickness burns of the abdominal wall

(arrow) and lower chest. There is extensive thermal tissue loss of the lower extremities and

thermal amputation of the right distal femur. Note the mottled lucency of the marrow

space, as well as skeletal muscle retraction with exposed distal bone that is characteristic of

thermal injury (arrowheads).

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Thermal flexion deformities may occur in severely charred bodies, and these are associated withfractures and dislocations from the mechanical forces associated with muscular contraction and

shrinkage. Thermal fractures are fine, linear cortical fractures in bone uncovered by soft tissue or

bone that are typically found in areas of severe charring. In contrast, traumatic fractures are

found in unexposed bone and are typical of mechanical injury, such as spinal compressionfractures and pelvic bone fractures.

Although traumatic long bone fractures may be difficult to differentiate from thermal fractures,

fractures in areas without charring and angulated fractures suggest a traumatic origin. Thecombination of retraction, flexion, dislocation, and fracture should facilitate the recognition that

the findings are due to thermal injury rather than injury that occurred before death or before thefire.12

Sharp force injury

Conventional radiography is considered an important component in the forensic assessment of sharp force injury to help identify and aid recovery of broken knife blades and to help

differentiate stab wounds from ballistic wounds.13

If knife blade fragments are present onradiography, the location of the fragment should correlate with the expected location of the

wound path based upon the skin entry site. On MDCT images, the wound track may bevisualized and lead to the metallic fragment.

The visibility of a wound on MDCT scans is dependent on the orientation and position of the

wound on the body. Skin wounds are characterized by a break in the continuity of the skin and

are outlined by air. The track in the body is visible if air is carried into soft tissue or released

from a gas-containing organ such as lung or bowel (see the image below)

Sagittal multidetector computed tomography (MDCT) scan of a stab wound to the back

that penetrates the spinal column. This image shows air in the wound track. The wound

has a horizontal orientation and passes between the posterior vertebral elements and into

the spinal canal, severing the spinal cord. The ends of the cord are retracted (arrows).

There is no break in the skin surface, which is likely due to closure of the wound from the

supine positioning of the body in the MDCT scanner.



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Sagittal multidetector computed tomography (MDCT) scan of a stab wound to the back

that penetrates the spinal column. This image shows air in the wound track. The wound





By viewing sequential images on a workstation or using multiplanar reconstructions it may

possible to determine the orientation and approximate length of the wound at the skin surface. It

may also be possible to estimate the depth of the wound if the wound track contains gas or if

there is adjacent bone injury. Air from venous air embolism may be seen in the right heart andvenous structures following stab wounds to the neck or wounding of any major vein that permits

air to enter the venous system.14

Internal hemorrhage may be seen in anatomic spaces where blood accumulates in sufficientvolume. Hemopneumothorax, hemoperitoneum, perinephric hematoma, and subcapsular

hemorrhage in intraabdominal organs are readily identified on MDCT images. Injuries to theheart are likely to cause hemopericardium with cardiac tamponade.14 The depth and direction of

the wound may be estimated by detecting injury to underlying bone and soft-tissue structures.

Drowning

MDCT scanning closely parallels autopsy for the depiction of the anatomic findings that are

supportive for the diagnosis of drowning. Sinus fluid, mastoid fluid, subglottic tracheal and bronchial fluid, and pulmonary ground glass opacity are consistently present on MDCT

images.15

Sinuses may be completely filled with fluid, contain air fluid levels, or contain highattenuation sand, which layers dependently in the sinus. Fluid and/or sand may be present within

the trachea and bronchi, as shown in the following 2 images.

Sagittal multidetector computed tomography (MDCT) scan of a victim with sand

aspiration in drowning. This image shows high-density sand throughout the pharynx.

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Sagittal multidetector computed tomography (MDCT) scan from a victim with sand

aspiration in drowning. This image of the chest shows sand filling the right and left

bronchi. Severe pulmonary edema is present.

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The presence of sinus and airway fluid is a very nonspecific finding, because it may found in

other forms of death or from decomposition. However, the presence of airway froth and sand

may be helpful indicators of drowning. Airway froth is characterized by heterogeneous lowattenuation fluid admixed with rounded foci of air. Sand, silt, or mud appears as high attenuation

material within the sinuses or airways on MDCT images. Pulmonary edema is the most

prominent lung finding of drowning on plain film radiography and MDCT scans. In mild

pulmonary edema, there are interstitial and septal lines, as depicted below. With more severeedema, alveolar edema is present. Dilated and engorged right-sided cardiac chambers and great

vessels may also be present. Even though these are nonspecific findings indicative of hypervolemia, they are helpful supportive findings when other anatomic findings of drowning

are present.

Coronal multidetector computed tomography (MDCT) scan from a victim with pulmonary

edema in drowning. This image of the lungs shows moderate pulmonary edema evenly

distributed throughout the lungs. Prominent septal lines are present in the bases and

apices.

[ CLOSE WINDOW ]



Coronal multidetector computed tomography (MDCT) scan from a victim with pulmonary

edema in drowning. This image of the lungs shows moderate pulmonary edema evenly

distributed throughout the lungs. Prominent septal lines are present in the bases and

apices.

Watery fluid similar to that of the drowning medium may be found in the stomach at autopsy.Sand, silt, or other debris from the drowning fluid may be present as well. The amount of fluid is

variable. Consequently, the degree of fluid distention of the stomach on MDCT images is not areliable indicator that drowning fluid has been ingested at the time of death.

Conclusions

Radiology is an integral part of forensic autopsy. Radiography alone is used in most centers.However, technologic advances in cross-sectional imaging have made it possible for MDCT

scanning to be used routinely with forensic autopsy. Cross-sectional imaging makes the



radiologic contribution to forensic autopsy more effective and may increase both the speed and

accuracy of forensic investigation.

Multimedia

(Enlarge Image)

Media file 1: Axial multidetector computed tomography (MDCT) scan of

the brain from a motor vehicle accident victim who died from

multisystem blunt trauma. This axial MDCT scan shows a

hyperattenuating acute right subdural hematoma (arrow). There is diffuse

edema of the right cerebral hemisphere, compression of the ventricular

system, and subfalcine herniation.

[ CLOSE WINDOW ]









herniation.

(Enlarge Image)

Media file 2: Axial multidetector computed tomography (MDCT) scan

of the brain from a motor vehicle accident victim who died from

multisystem blunt trauma. This axial MDCT scan shows subarachnoid

hemorrhage adjacent to the cerebellar vermis (arrow). A small amountof intraventricular hemorrhage is also present. The intracranial gas and

loss of gray and white matter differentiation is due to decomposition.

[ CLOSE WINDOW ]





subarachnoid hemorrhage adjacent to the cerebellar vermis (arrow). A small amount of

intraventricular hemorrhage is also present. The intracranial gas and loss of gray and


(Enlarge Image)

Media file 3: Axial multidetector computed tomography (MDCT) scan of

the brain from a motor vehicle accident victim who died from

multisystem blunt trauma. This axial MDCT scan shows a depressed

skull fracture of the right parietal temporal region (arrow) and fracture of the left frontal sinus with overlying soft-tissue defect. The brain has

retracted from decomposition, and there is decompositional gas within

the cranium.

[ CLOSE WINDOW ]










(Enlarge Image)

Media file 4: Three-dimensional multidetector computed tomography

(MDCT) scan of the head from a motor vehicle accident victim who died

from multisystem blunt trauma. This MDCT scan shows the right-sided

depressed skull fracture (arrow) and a left frontal fracture that extends tothe orbit (arrowhead ). There is streak artifact from dental restoration.

[ CLOSE WINDOW ]







shows the right-sided depressed skull fracture (arrow) and a left frontal fracture that

extends to the orbit (arrowhead ). There is streak artifact from dental restoration.

(Enlarge Image)

Media file 5: Frontal radiograph of the chest from a victim of a

gunshot wound to the chest. This image shows metallic bullet

fragments overlying the heart and right lower chest. There are

right posterior rib fractures and a bilateral pneumothoraces.

[ CLOSE WINDOW ]






shows metallic bullet fragments overlying the heart and right lower chest. There are right

posterior rib fractures and a bilateral pneumothoraces.

(Enlarge Image)

Media file 6: Coronal multidetector computed tomography

(MDCT) scan of the chest from a victim of a gunshot wound to

the chest. This image shows a gas-filled gunshot wound track

that extends from the left upper lobe (arrow) to the right lower lobe. Metallic bullet fragments are located in the right lower lung

and adjacent to the right hemidiaphragm. The increased density

surrounding the gunshot wound track is hemorrhage.

[ CLOSE WINDOW ]







extends from the left upper lobe (arrow) to the right lower lobe. Metallic bullet fragments

are located in the right lower lung and adjacent to the right hemidiaphragm. The increased


(Enlarge Image)


(MDCT) scan of the chest from a victim of a gunshot wound to

the chest. This image shows a gas-filled gunshot wound track

that extends from the left upper lobe to the right lower lobe.Metallic bullet fragments are located in the right lower lung and

adjacent to the right hemidiaphragm. The increased density

surrounding the gunshot wound track is hemorrhage.

[ CLOSE WINDOW ]





extends from the left upper lobe to the right lower lobe. Metallic bullet fragments are

located in the right lower lung and adjacent to the right hemidiaphragm. The increased


(Enlarge Image)

Media file 8: Axial multidetector computed tomography (MDCT) scan

from an aviation accident victim who died from blunt trauma before the

fire of the crash. This image of the lower face and neck shows a complex

cervical spine fracture dislocation with transection of the cervical cord.Mandibular fractures are also present. Note the presence of full-thickness

burns by the irregular contour of the subcutaneous fat and focal areas of

thermal tissue loss (arrowheads).

[ CLOSE WINDOW ]




who died from blunt trauma before the fire of the crash. This image of the lower face and



neck shows a complex cervical spine fracture dislocation with transection of the cervical



(arrowheads).

(Enlarge Image)

Media file 9: Coronal multidetector computed tomography (MDCT) scan

from an aviation accident victim who died from blunt trauma before the

fire of the crash. This maximum intensity projection image shows acomplex fracture of the sacrum, pelvis, and right femur.

[ CLOSE WINDOW ]






victim who died from blunt trauma before the fire of the crash. This maximum intensity

projection image shows a complex fracture of the sacrum, pelvis, and right femur.

(Enlarge Image)

Media file 10: Coronal multidetector computed tomography (MDCT) scan

of full-thickness burns and thermal amputation in a motor vehicle crash

victim. This image of the abdomen and lower extremities shows thermal

tissue loss with full-thickness burns of the abdominal wall (arrow) andlower chest. There is extensive thermal tissue loss of the lower extremities

and thermal amputation of the right distal femur. Note the mottled lucency

of the marrow space, as well as skeletal muscle retraction with exposed

distal bone that is characteristic of thermal injury (arrowheads).

[ CLOSE WINDOW ]












(Enlarge Image)

Media file 11: Sagittal multidetector computed tomography (MDCT) scan

of a stab wound to the back that penetrates the spinal column. This imageshows air in the wound track. The wound has a horizontal orientation and

passes between the posterior vertebral elements and into the spinal canal,

severing the spinal cord. The ends of the cord are retracted (arrows).

There is no break in the skin surface, which is likely due to closure of thewound from the supine positioning of the body in the MDCT scanner.

[ CLOSE WINDOW ]









(Enlarge Image)

Media file 12: Sagittal multidetector computed tomography (MDCT) scan

of a victim with sand aspiration in drowning. This image shows high-

density sand throughout the pharynx.

[ CLOSE WINDOW ]







(Enlarge Image)

Media file 13: Sagittal multidetector computed tomography

(MDCT) scan from a victim with sand aspiration in drowning.

This image of the chest shows sand filling the right and left


[ CLOSE WINDOW ]






(Enlarge Image)


(MDCT) scan from a victim with pulmonary edema in drowning.

This image of the lungs shows moderate pulmonary edema

evenly distributed throughout the lungs. Prominent septal lines

are present in the bases and apices.

Documents

Postmortem Radiology and Imaging