By

Ayman M AbdelfatahAssistant lecturer

Department of Forensic Medicine – ASU2009-2010

1. Diagnosis of hidden injuries2. Diagnosis of hidden foreign bodies3. Permanent record 4. Lacks emotional impact of photographs

• It should be done:– In every case of trauma– Before surgical interference or postmortem

dissection

I. Soft tissue injury:1-Swelling, edema or hemorrhage: Subdural hematoma around frontal lobe (arrows) on CT.

I. Soft tissue injury:2-Laceration of an organ: knife wound to the heart (arrow) shown by MRI

I. Soft tissue injury:3-Abnormal collection of air in the chest → pneumothorax: Right-sided pneumothorax (arrow) on plain CXR

I. Soft tissue injury:3-Abnormal collection of air in the chest → pneumothorax: Left-sided pneumothorax (arrow) on CT scan of the chest with chest tube in place

II. Fractures:1. Hidden fractures: An infant who was hit in the back of the head with a blunt weapon, and sustained a separation of the odontoid process from the body of C2 with anterior subluxation of C1. Note separation of the spinous processes at the level of injury.

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → skull

Skull fissures on plain XR Skull fissures on CT

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → Long bones → metaphyseal fractures (avulsion and dislocation of epiphyseal ends): Typical bucket-handle metaphyseal fracture of the distal humerus on plain XR.

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → Long bones → metaphyseal fractures: Corner fractures of the distal femur and proximal tibia

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → Long bones → diaphyseal fractures: Healing displaced transverse fracture of the femur in a 4-month-old abused infant

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → healed lateral rib fractures

II. Fractures:2. Battered child cases:

A. Multiple regional fractures → healed posterior rib fractures

II. Fractures:2. Battered child cases:

B. Fractures of different ages: a new rib fracture (arrow) through one of the old, healed fractures.

III. Foreign bodies: stabbing by glass

III. Foreign bodies: Glass: A beer bottle was smashed against the right frontal area of this victim, producing a fracture (arrows) and shattering the bottle as well. A piece of the bottle penetrated the scalp and stuck in the outer table of the skull (open arrow).

III. Foreign bodies: broken blade: Broken knife in the face (arrows)

III. Foreign bodies: Stab into the head. This is the second unsuccessful attempt to murder this victim. A preceding attempt has left a piece of wire (arrow) above and posterior to the sella.

III. Foreign bodies: bullets: Fragmented bullet within the head and neck areas of a gunshot wound victim.

III. Foreign bodies: bullets: A bullet traversed the posterior elements of the C-1 vertebra (small arrows), impacted on the posterior body of C-2 (open arrows), then dropped in the spinal canal before coming to rest at the C-5 level (large arrow).

III. Foreign bodies: shots:A shotgun wound to the back injured the right kidney. The two pellets overlying the lower pelvis entered the urinary bladder (arrow) after passing through the right ureter.

III. Foreign bodies: Retained instruments after surgery: clamp

III. Foreign bodies: Retained instruments after surgery: curved needle (arrow)

III. Foreign bodies: Retained sponge after surgery

I. Deductive identification:• Sex: radiographs of skull, pelvis and sternum. • Age:

– Appearance of ossific centers– Union of epiphysial plates– Calcification of laryngeal and costal cartilages– Skull radiographs for examination of fontanels, sutures and

teeth.

• Race• Stature

II. Comparative Identification: Depends on comparing antemortem to postmortem X-Rays of a

person. Comparison includes:• Normal structures: comparison of skull sinuses

especially frontal sinuses regarding the size and shape. • Abnormal structures: congenital anomalies of bones,

deformities and/or fractures. • Dental radiographs: comparing root shapes, teeth

fillings and abnormal teeth eruptions.

I. Addictive agents (body packer):Abdominal radiograph of a body packer showing rounded and ovoid, slightly hyperdense packages, some of which are clearly surrounded by a halo of entrapped gas or air (some are marked with arrows).

I. Addictive agents (body packer):CT images of a body packer shows multiple drug packages somewhat denser than the bowel, most of which contain entrapped air at the ends of the packages.

II. Jewels (larceny by ingestion):Radiograph of the abdomen of a suspected jewel thief. Note the dense object (arrow) in the shape of a brilliant cut diamond.