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The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52-92) at the time of death. The mean time elapsed since death was 29.1 h (12.0-72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3-4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: To evaluate the usefulness of the applied freezing technique in putrefied brain for macroscopic investigation., Materials and Methods: From October 2015 to September 2016, first the brains of 10 cadavers (control group: male 6, female 4, age 20-80 (mean 61.5), postmortem intervals (PMI) 14-75 (mean 29.7)days) were inspected following the standard practice (without freezing preparation), and then with 10 cadavers (freezing group: male 7, female 3, age 41-88 (mean 60.4), PMI 7-75 (mean 29.2)days) the freezing technique was used before the autopsy. The cut brain was investigated, and the gray-white matter difference was evaluated macroscopically., Results: In the control group, the brain parenchyma leaked out like sludge in 5, and there was difficulty maintaining its structure in 7. The gray-white matter difference was well visible in 3, but hard to distinguish in 3, and the total scores ranged from 0 to 9 (mean 4.4) points. In the freezing group, the entire putrefied brain was extracted as a solid organ, the gray-white matter differences were well visible, and the total scores were 6.7-9 (8.3) points. The gray-white matter difference was preserved in the freezing group (p<0.05)., Conclusion: The freezing procedures to evaluate the putrefied brain have been successfully applied, and it could be statistically more useful in putrefied brain investigation than the ordinary procedure. Postmortem CT can be useful to evaluate not only the degree of brain putrefaction, but also the degree of brain parenchyma freezing., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: We retrospectively evaluated the cerebro-spinal fluid (CSF) CT density at the lateral ventricle to compare the postmortem intervals in cadavers., Materials and Methods: The number of cadavers enrolled in this study was 189 (male 120, female 69). According to the estimated postmortem time, the cadavers were divided into 13 groups (postmortem day 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 7, 10, 14, 21, 30), and were also re-grouped into 3 groups according to the postmortem time-width: group A (postmortem day 0.5-2.5), group B (day 3-7), and group C (day 10-30). Comparisons between the CSF density and estimated postmortem time were also analyzed., Results: The CSF density was around 20HU up to day 2.5, and it increased gradually after day 3. Day 3 and 4 presented higher CSF density than day 1 and 1.5 (p<0.05). Day 7 presented higher CSF density than day 3 (p<0.05). According to the postmortem time-width, the CSF density increased with postmortem time (p<0.05). The simple linear regression equations presented negative correlation between CSF density and estimated postmortem time, and R(2) was 0.119., Conclusion: The CSF density increased, but not linearly, according to the postmortem time, and the 3rd postmortem day was the earliest time allowing the difference to be detected. The CSF density needs further evaluation to enable estimation of the postmortem time., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Obstructive sleep apnea syndrome (OSAS) induces upper airway occlusion and may cause sudden death during sleep. This study sought to clarify the relationship between oral air space volume and OSAS onset, which is influenced by multiple factors, such as jawbone, dentition morphology, and oral soft-tissue volume. Methods: (1) 50 subjects from deceased cases were divided into two groups: OSAS (25 subjects) and controls (25 subjects). (2) 28 subjects from clinical cases were divided into two groups: OSAS (9 subjects) and controls (19 subjects). In all cases, the Computed Tomography (CT) images of the facial region were obtained, and four parameters of oral area volume were analyzed in deceased and clinical cases, and comparisons and analyses were performed between OSAS and control cases. In addition, the efficiency of measurement of these parameters was evaluated using Receiver Operating Characteristic (ROC) curves in OSAS. Results: (1) In deceased cases, oral soft-tissue volume (OSV), oral air-space volume (OAV), and the ratio of OAV to OSV (%air) showed a significant correlation. (2) In clinical cases, OAV and %air showed a significant correlation. In both postmortem and clinical images, a small %air value indicates a high risk of developing OSAS and a high probability of OSAS-related sudden death. Conclusions: It was shown that the %air is an index to evaluate OSAS by CT imaging of the oral region. OSAS may be indicated when the %air value is ≦ 16.0% in deceased cases and ≦ 6.6% in clinical cases. [ABSTRACT FROM AUTHOR]

Highlights • Lung weight was measured in autopsy and compared with postmortem CT, including a great variety of congested/edematous lung. • The lung weight showed a high correlation coefficient between autopsy and estimated using postmortem CT. • Using postmortem CT, the lung weight can be estimated in forensic settings. Abstract Postmortem computed tomography (CT) is a minimally invasive technique to examine internal organs before a forensic autopsy. The purpose of our study was to estimate lung weight in a forensic setting in cases of various lung states, including fluid accumulation (congestion, edema, hypostasis, and inflammation etc.) using postmortem CT. From January 2016 to July 2018, 111 deceased bodies (62 males and 59 females, aged from 18 to 95 (average 59.6) years) were examined by CT before autopsy. Both lungs of the 111 deceased were analyzed separately, making it a total of 222 samples. We extracted lung fields from CT images manually after semi-automatic detection using an image workstation. The total lung volume and 6 categories of lung volume divided according to their CT density were measured. Multiple regression analysis was performed with lung weight in autopsy as the response variable, while the 6 categories were labelled as explanatory variables. The relation between lung weight in autopsy and lung weight estimated using postmortem CT showed a high Pearson's correlation coefficient (R2 = 0.9106). Using postmortem CT, the lung weight can be estimated in forensic settings. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to estimate the lung weight using postmortem CT in well aerated lung autopsy cases. The correlation coefficients to the lung weight were also evaluated for the cadavers’ height, weight, whole body surface area (WBSA), body mass index, and estimated lung volume. Materials and methods From October 2015 to July 2016, 31 cadavers (male 12, female 19, age 20–98 (mean 66.9) y.o., postmortem interval 0.3–75.0 (5.7) days) were compared as regards body weight, height, whole body surface area (WBSA), body mass index (BMI), lung volume on CT, and total lung volume classified into several CT number categories, with their lung weight in autopsy. Results The lung weight (mean ± SE) was 284.9 ± 14.8 g in right lung and 249.3 ± 12.9 g in left lung. The %ALV was 79.9 ± 0.9 HU (mean ± standard error (SE)) in both lungs, 80.3 ± 1.3 HU in right lung, and 77.6 ± 2.0 HU in left lung. Using a simple linear regression test, there was no statistically significant correlation between the lung weight and the categories (R 2 : body height 0.234, weight 0.224, WBSA 0.309, BMI 0.046, lung volume 0.059). The volume for each individual CT density category showed no significant correlation, but the stepwise regression test yielded an excellent correlation coefficient (R 2  = 0.840). Conclusion The well aerated lung weight was 284.9 ± 14.8 g in right lung and 249.3 ± 12.9 g in left lung, and the postmortem CT could estimate the lung weight with high correlation coefficient. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the usefulness of freezing preparation for macroscopic investigation in advanced putrefied brain. Materials and methods After sealing in individual plastic bags, 10 pig heads were stored at 20 °C for 5 days allow postmortem change (putrefaction) to progress. After an observation period, they were divided into 2 groups to evaluate the usefulness of the freezing effect in macroscopic investigation. The process over the postmortem period and the freezing process were examined. Results At day-5, the presence of air density was detected between the inner surface of the cranium and the brain parenchyma. Intra-cranial air accumulation presented on CT in all heads. In the control group, the brain parenchyma leaked out from the hole in the meninges, and the gray-white matter difference was clear in 3/72 (4.2%), moderate in 7/72 (9.7%), ambiguous in 17/72 (23.6%), and poor in 45/72 (62.5%). In the freezing group, the brain parenchyma presented homogeneous low density after more than 14 h freezing. On opening the cranium, the entire brains were frozen, and the gray-white matter difference was clear in 33/72 (46.0%), moderate in 17/72 (24.0%), ambiguous in 15/72 (21.0%), and poor in 7/72 (10.0%). The freezing group afforded greater clarity in the gray-white matter inspection (p < 0.05). Conclusion Freezing preparation was useful for the macroscopic investigation of putrefied brain compared with the ordinary autopsy. [ABSTRACT FROM AUTHOR]

• n -Butyric acid levels were significantly higher in the decomposed groups. • High concentration of n -butyric acid detected when blood decomposed. • n -Butyric acid levels higher than n -propanol in some cases in the decomposed group. • n -Butyric acid may reflect blood decomposition more sensitively than n -propanol. In forensic medicine, although various alcohols have been reported as indicators of decomposition in collected blood, no studies have examined short-chain fatty acids as indicators. In this study, the blood n -butyric acid concentration was quantified, and the association between n -butyric acid and decomposition was investigated to determine whether the detection of n -butyric acid could be a new indicator of decomposition. Among the forensic autopsies performed from 2016 to 2018 in our laboratory, the cases were divided into decomposed (n = 20) and non-decomposed (n = 20) groups based on macroscopic findings. Blood samples collected at the time of autopsy were derivatized with 3-nitrophenylhydrazine hydrochloride after solid-phase extraction. The n -butyric acid concentration was measured using liquid chromatography–tandem mass spectrometry. In addition, ethanol and n -propanol were measured using a gas chromatography-flame ionization detector. There was a significant difference (p < 0.01) in the concentrations of n -butyric acid between the decomposed and non-decomposed groups (0.343 ± 0.259 [0.030–0.973] and 0.003 ± 0.002 [0.001–0.007] mg/mL, respectively). In the decomposed group, n -butyric acid was detected at high concentrations, even in cases where n -propanol was low. These results suggest that n -butyric acid is more likely to be an indicator of blood decomposition than n -propanol. [ABSTRACT FROM AUTHOR]

Abstract: Previous studies have reported that the concentration of thyroglobulin (Tg) in heart blood is high in cases of asphyxia by neck compression such as hanging, strangulation, and throttling and in those with traumatic injuries to the head. However, we have experienced cases in which we observed high Tg concentrations without such findings. Therefore, we analyzed the influence of postmortem changes on Tg concentration. Of 253 forensic autopsies conducted at our institution, we analyzed 44 cases without the findings presumed to increase Tg concentration. We collected right heart blood (RHB) and left heart blood (LHB) separately and measured Tg concentrations in each. The Tg concentration of the RHB in 19 (43%) cases and that of the LHB in 10 (23%) cases was higher than the standard value (200ng/ml) obtained in previous studies. In some cases, we found large differences between the Tg concentrations of RHB and LHB. We suggest that Tg concentration can increase above the standard value and that a difference between the Tg concentration of RHB and LHB arises as a result of postmortem changes. Consequently, if there is a large difference between the Tg concentration of RHB and LHB, the concentration of Tg should not be used as a basis for forensic diagnosis. [Copyright &y& Elsevier]

Abstract: An old man was found dead in a rice paddy with his face down in the water. His right forearm and hand were severely injured and the shapes of injuries were unusual. It was initially suspected that the injuries had been caused by a cultivator placed at the site. However, they proved to be postmortem injuries because vital reactions were not observed. The skin was widely torn away. Some edges of the injuries looked like a bite mark and other parts looked like scratches. There were many parallel injuries on the right forearm and hand and footmark-like injuries on the right hand. They were probably caused by wild animals. Judging from the sizes and shapes of the footprint, bite marks and scratches, we estimated that the animal which caused the injuries was weasels. [Copyright &y& Elsevier]

Abstract: In Sapporo city, located in the northern district of Japan, it is very difficult to estimate the time of death of decomposed or skeletonized bodies found outdoors in cold season (November–April) because postmortem changes are markedly retarded in the season compared with warm season (May–October), and the bodies are often damaged and skeletonized by carnivorous animals such as wild dogs and foxes. However, they cannot damage the brain in the cranium. The brain is mainly damaged by fly larvae. In Sapporo city, we can estimate that the time of death of a cadaver found outdoors in the cold season is in the beginning of November or before if fly larvae hatched in autumn exist on the cadaver, and that the time of death is in the beginning of November or after if fly larvae hatched in autumn do not exist and most of the brain remains in the cranium. [Copyright &y& Elsevier]

• Asthma is a new differential diagnosis for lung hypo-attenuation on computed tomography (CT) scans. • There are few other specific post-mortem manifestations of fatal asthma on post-mortem computed tomography and standard autopsy. • It is important to utilise information from a patient's history to guide further biochemical and histo-pathological investigations. Ground glass attenuation (GGA) of the lungs is a common finding of post-mortem computed tomography (PMCT) that is associated with pulmonary congestion and edema due to cardiac failure during the agonal period, or due to post-mortem hypostasis. However, hypo-attenuation of the lung is an atypical finding of PMCT, and is usually a consequence of hypovolemic states before death or postmortem body posture after death. Previous studies have shown a few differential diagnoses, such as hypothermia, massive hemorrhage, asphyxiation by hanging, and dehydration, for hypo-attenuation of the lung. This report presents the case of a woman who died suddenly because of an asthma attack. Our PMCT analysis demonstrated hypoattenuation of the lung in this case. We suggest fatal asthma as a differential diagnosis for the appearance of hypo-attenuation of lungs on PMCT. [ABSTRACT FROM AUTHOR]