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Böckers A, Steinhoff S, Scholl T, Kunz SN. [Suicidal gas embolism in hospital]. Rechtsmedizin (Berl) 2021; 32:271-276. [PMID: 34539087 PMCID: PMC8438279 DOI: 10.1007/s00194-021-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Luftembolien sind im klinischen Alltag nach traumatischen oder iatrogenen Ereignissen eine häufig zu beobachtende Entität. Fälle einer in suizidaler Absicht herbeigeführten Luftembolie sind selten. Die Konnektivität von luft- und flüssigkeitsführenden Schlauchsystemen ermöglicht die Zufuhr großer Gasmengen in kurzer Zeit mit häufig tödlichem Ausgang. Der Einsatz einer Computertomographie vor der Obduktion ist in solchen Fällen obligat und ermöglicht eine umfassende Darstellung der zugeführten Gasmengen. Wir präsentieren den ungewöhnlichen Fall einer suizidalen venösen Gaszufuhr mittels eines stationären Sauerstoffgerätes in einem Krankenhaus.
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Affiliation(s)
- A Böckers
- Institut für Rechtsmedizin, Universitätsklinikum Ulm, Prittwitzstr. 6, 89075 Ulm, Deutschland.,Universität Ulm, Ulm, Deutschland
| | - S Steinhoff
- Radiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - T Scholl
- Pathologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian N Kunz
- Institut für Rechtsmedizin, Universitätsklinikum Ulm, Prittwitzstr. 6, 89075 Ulm, Deutschland.,Universität Ulm, Ulm, Deutschland
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3
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Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions. Forensic Sci Med Pathol 2020; 16:3-11. [PMID: 31463781 PMCID: PMC7069893 DOI: 10.1007/s12024-019-00162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0–48 days) and 0.01 day (0–1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.
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Torimitsu S, Makino Y, Saka K, Fujii Y, Abe H, Chiba F, Yamaguchi R, Iwase H. Olanzapine-Induced Fatal Ketoacidosis with Pneumomediastinum and Subcutaneous Emphysema. J Forensic Sci 2018; 64:930-933. [PMID: 30372789 DOI: 10.1111/1556-4029.13942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
Abstract
We report a case of fatal olanzapine-induced ketoacidosis in which pneumomediastinum (PM) and subcutaneous emphysema (SE) were detected on postmortem computed tomographic (CT) images. A man in his forties was found in a state of cardiopulmonary arrest with profuse perspiration, and 50 empty capsules of olanzapine (10 mg) and flunitrazepam (1 mg) were found in his room. The major findings of postmortem CT prior to autopsy were PM and SE from the lower half of the face to the height of the first rib. The results of autopsy, biochemical tests, and toxicological analyses indicated the cause of death to be fatal ketoacidosis induced by olanzapine intoxication. No injuries, medical interventions, or particular diseases were evident, suggesting that PM and SE were caused by ketoacidosis. Our findings indicated that toxicological analyses should be performed when PM and SE are detected on CT images.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kanju Saka
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yusuke Fujii
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroko Abe
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Johnson GA, Smith P, Robinson J, Collis SA, Johnson CP. The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism. MEDICINE, SCIENCE, AND THE LAW 2018; 58:176-182. [PMID: 29996706 DOI: 10.1177/0025802418785709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pathologists providing a coronial autopsy service are very reliant on the information, including that concerning the body at the scene, provided prior to the post-mortem examination. This ensures the case is appropriate for a non-forensic autopsy and allows proper interpretation of the pathological and laboratory findings. We present the results of an audit of the extent and accuracy of the information provided (in terms of a set of descriptors), in relation to the body at the scene; whether just the information on the coronial autopsy request form 97a is used, or if it is supplemented with details from the police form 97 and statements from attending officers and scene witnesses. The scene photographs were then reviewed to assess the accuracy of the other information sources and their value to the reporting pathologist. The audit showed that scene photographs are undertaken surprisingly frequently (29.6%) but this was only clear from the coronial request in 22% of referrals. More information was consistently available in the police information for most of the scene descriptors. This was usually accurate, but only partially so, with an average of 19% of relevant features. Viewing the scene photographs was deemed beneficial or essential in 51% and 41.1% of cases. The value of scene photography is then illustrated in a case of suspected suicidal venous air embolism, where subsequent review of the images pointed strongly to the rapidity of death, with minimal blood loss but obvious targeting of a very large varicose saphenous vein in the upper thigh.
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Affiliation(s)
- George A Johnson
- 1 Guy's, King's and St Thomas's School of Medical Education, King's College London, UK
| | - Philip Smith
- 2 Accident and Emergency Department, Aintree University Hospital NHS Foundation Trust, UK
| | - Jamie Robinson
- 3 Forensic Pathology Unit, Department of Pathology, Royal Liverpool University Hospital, UK
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Makino Y, Itoda N, Ikegaya H, Tanaka N, Kinoshita H, Motomura A, Uno T, Iwase H. Search and removal of radioactive seeds: another application of postmortem computed tomography prior to autopsy. Int J Legal Med 2016; 130:1329-32. [DOI: 10.1007/s00414-016-1404-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022]
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Postmortem-computed tomography and postmortem-computed tomography-angiography: a focused update. Radiol Med 2015; 120:810-23. [PMID: 26088469 DOI: 10.1007/s11547-015-0559-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 01/20/2023]
Abstract
The use of multidetector CT (MDCT) represents a reality routinely used in several forensic institutes, for the numerous advantages that this diagnostic tool can provide; costs are becoming increasingly lower; data acquisition is always faster and once acquired may be revalued at any time. However, there are also some diagnostic limitations, for example, the visualization of the vascular system or a limited soft tissue contrast. In order to overcome these limitations, in recent years, contrast medium has been introduced in postmortem cases, with the development of several techniques of PMCT angiography (PMCTA) and standardized protocols to make them easily reproducible. The aim of this review is to highlight the advantages and pitfalls of PMCT and PMCTA in forensic investigation, taking into consideration the broad spectrum of applications both for natural and unnatural deaths and the numerous methods currently used. Secondly, in the light of the considerable progress in this field and the attempt to develop standardized protocols of PMCTA, the authors aim to evaluate the diagnostic value of PMCTA in comparison both to PMCT and conventional autopsy.
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