Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body

Elena F Kranioti; Despoina Nathena; Konstantinos Spanakis; Apostolos Karantanas; Ralph Bouhaidar; Siobhan McLaughlin; Michael J Thali; Garyfalia Ampanozi

doi:10.1016/j.jflm.2020.102093

Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body

J Forensic Leg Med. 2021 Jan:77:102093. doi: 10.1016/j.jflm.2020.102093. Epub 2020 Dec 7.

Authors

Elena F Kranioti¹, Despoina Nathena², Konstantinos Spanakis³, Apostolos Karantanas⁴, Ralph Bouhaidar⁵, Siobhan McLaughlin⁶, Michael J Thali⁷, Garyfalia Ampanozi⁸

Affiliations

¹ Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK. Electronic address: ekranioti@uoc.gr.
² Forensic Medicine Unit, Department of Forensic Sciences, Medical School, University of Crete, Heraklion, Greece. Electronic address: dnathena@yahoo.gr.
³ Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece. Electronic address: vispan@windowslive.com.
⁴ Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece. Electronic address: akarantanas@gmail.com.
⁵ Division of Forensic Pathology, Medical School, University of Edinburgh, UK; Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK. Electronic address: ralph.bouhaidar@ed.ac.uk.
⁶ Edinburgh Forensic Radiology and Anthropology Imaging Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK. Electronic address: siobhan.mclaughlin@nhslothian.scot.nhs.uk.
⁷ Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland. Electronic address: michael.thali@irm.uzh.ch.
⁸ Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland. Electronic address: garyfalia.ampanozi@irm.uzh.ch.

PMID: 33316735
DOI: 10.1016/j.jflm.2020.102093

Abstract

Traffic incidents are one of the most frequent causes of death in young adults worldwide. Depending on the location of the incident, the velocity of the vehicle(s), the weather condition, traffic incidents are often complicated making the investigation of the circumstances difficult. Here we report a case of an incinerated body involved in a vehicle incident. Differential diagnosis included natural cause of death during driving, fatal traumatic injuries, death due to fire and positional asphyxia. The body was submitted to PMCT prior to autopsy as part of a research protocol (N. 1388/2016) at the Department of Medical Imaging of the University Hospital of Heraklion in Crete, Greece. Unenhanced PMCT revealed craniofacial fractures, a thin film of subdural haemorrhage and an epidural fluid collection. The findings were interpreted as consistent with an impact to the face, causing craniofacial fractures mainly on the right side, and an acute subdural hematoma. Autopsy findings corroborated the diagnosis. The epidural hematoma was deemed to be post-mortem heat-induced. This case is an excellent example of the diagnostic value of PMCT in the medicolegal investigation of death.

Keywords: Brain injury; Forensic pathology; Heat hematoma; PMCT; Subdural hematoma.

Publication types

Case Reports

MeSH terms

Accidents, Traffic
Autopsy / methods
Burns
Facial Bones / diagnostic imaging
Facial Bones / injuries
Fires*
Hematoma, Subdural / diagnostic imaging*
Hematoma, Subdural, Acute / diagnostic imaging*
Humans
Male
Skull Fractures / diagnostic imaging*
Tomography, X-Ray Computed*
Young Adult