Legal Medicine最新文献_第6页

Enhancing the detection of ECMO-related morphological changes: a post-mortem observational study and systematic review 加强ecmo相关形态学改变的检测：一项死后观察研究和系统综述。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-15 DOI: 10.1016/j.legalmed.2025.102713

Andrea Scatena , Julia Lazzari , Pietro Bertini , Valentina Bugelli , Marco Di Paolo

Extracorporeal Membrane Oxygenation (ECMO) is a crucial life-support technology used in intensive care medicine for patients with severe cardiorespiratory failure who do not respond to conventional treatments. While ECMO can be lifesaving, it is a complex procedure that demands a multidisciplinary approach and a thorough understanding of its indications, contraindications, complications, and limitations. The application of ECMO also presents significant challenges for forensic medicine, as patients who undergo ECMO and later die may exhibit physiological changes that can lead to discrepancies between pre-mortem and post-mortem diagnoses. These changes can complicate the interpretation of autopsy findings and impact forensic conclusions. “A systematic review along with eight cases studies dealing with patients died after treatment with ECMO have been reported”. Each case underwent forensic autopsy to illustrate the potential post-mortem changes associated with ECMO and highlight the importance of understanding these effects when evaluating forensic cases. The authors propose a procedure for conducting an external examination before initiating ECMO treatment or during the initial hours of treatment to document and preserve the clinical condition in cases of forensic interest. This approach aims to provide a clearer and more accurate basis for forensic analysis, ensuring that any alterations due to ECMO are properly accounted for during autopsy.

体外膜氧合（Extracorporeal Membrane Oxygenation， ECMO）是重症监护医学中对常规治疗无效的严重心肺衰竭患者至关重要的生命支持技术。虽然ECMO可以挽救生命，但它是一个复杂的过程，需要多学科的方法和对其适应症、禁忌症、并发症和局限性的全面了解。ECMO的应用也给法医学带来了重大挑战，因为接受ECMO并随后死亡的患者可能会表现出生理变化，从而导致死前和死后诊断之间的差异。这些变化可能使尸检结果的解释复杂化，并影响法医结论。“据报道，一项系统综述和8例病例研究处理了经体外膜肺氧合治疗后死亡的患者”。每个病例都进行了法医尸检，以说明与ECMO相关的潜在死后变化，并强调在评估法医病例时了解这些影响的重要性。作者建议在开始ECMO治疗前或在治疗的最初几个小时内进行外部检查，以记录和保存法医感兴趣的病例的临床状况。该方法旨在为法医分析提供更清晰、更准确的基础，确保在尸检过程中妥善考虑ECMO造成的任何改变。

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引用次数: 0

Commotio cordis: Insights from a case of blunt chest trauma and a road map for the correct diagnosis 心动症：钝性胸外伤1例及正确诊断指南。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-14 DOI: 10.1016/j.legalmed.2025.102714

Francesco Calabrò , Alessandra Puggioni , Davide Machado , Valentina Bugelli

Commotio cordis (CC) is a rare cause of sudden cardiac death resulting from a blunt, non-penetrating impact to the precordium, in the absence of underlying cardiac pathology or structural damage. Although most frequently described in adolescents engaged in sports activities, CC may also occur in non-sport contexts. We report the case of a 43-year-old male construction worker who died after being struck in the chest by a slow-moving truck. Postmortem computed tomography (PMCT) revealed multiple left rib fractures, costal cartilage fractures, manubriosternal dislocation and pulmonary contusions. Conventional autopsy confirmed the absence of cardiac rupture, coronary disease or pericardial injuries. Histological analysis supported a diagnosis of electromechanical dissociation by fatal arrhythmia.

In our review of six previously published articles involving similar cases, autopsy was the principal diagnostic tool in all instances. PMCT was employed in only one case, prompted by circumstantial suspicion of child abuse.

This case underscores the importance of a multidisciplinary forensic approach, combining PMCT and traditional autopsy to reconstruct the traumatic event and rule out other mechanisms of death. CC remains a diagnosis of exclusion, requiring demonstration of precordial impact, absence of lethal structural injuries, and lack of alternative causes of death on autopsy and toxicological examination.

PMCT should be strongly recommended in cases of sudden death following blunt thoracic trauma, even when external signs are minimal or absent.

心动症（CC）是一种罕见的心源性猝死原因，是在没有潜在心脏病理或结构损伤的情况下，心前膜受到钝性、非穿透性撞击所致。虽然最常发生在从事体育活动的青少年中，但CC也可能发生在非体育环境中。我们报告一名43岁男性建筑工人在被一辆缓慢移动的卡车击中胸部后死亡。死后电脑断层扫描（PMCT）显示左肋多处骨折，肋软骨骨折，胸骨脱位和肺部挫伤。常规尸检证实无心脏破裂、冠状动脉疾病或心包损伤。组织学分析支持由致死性心律失常引起的机电分离的诊断。在我们回顾了六篇先前发表的涉及类似病例的文章中，尸检是所有病例的主要诊断工具。PMCT只在一起案件中被使用，这是由于对虐待儿童的间接怀疑。这个案例强调了多学科法医方法的重要性，结合PMCT和传统尸检来重建创伤事件并排除其他死亡机制。CC仍然是一种排除性诊断，需要证明心前撞击，没有致命的结构损伤，并且在尸检和毒理学检查中缺乏其他死亡原因。强烈建议在钝性胸外伤后猝死的病例中进行PMCT，即使外部体征很小或没有。

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引用次数: 0

Postmortem computed tomography-based evaluation of brain decomposition: Correlation with postmortem interval and cause-of-death determinability 基于死后计算机断层扫描的脑分解评估：与死后间隔和死因确定的相关性。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-13 DOI: 10.1016/j.legalmed.2025.102710

Haruki Fukuda , Hiroyuki Tokue , Miyuki Shiraishi , Takuya Ishikawa , Akari Kimimura , Kensuke Takatsu , Kouji Oka , Rieko Kubo , Tadashi Hosoya

Background

Accurately estimating the postmortem interval (PMI) is essential for forensic investigations. Brain decomposition observed on postmortem computed tomography (PMCT) may provide useful markers to estimate PMI; however, this approach has not been extensively studied. The aim of this study was to classify and quantify brain decomposition using PMCT findings and to investigate its association with PMI, determinability of cause of death, and environmental factors.

Methods

We retrospectively analyzed 176 adult autopsy cases involving preautopsy PMCT. Brain decomposition was classified into five stages using the visual PMCT findings and quantified using brain area-to-length ratios on axial computed tomography slices. Associations between the PMI and determinability of the cause of death were assessed using correlation and regression analyses.

Results

Brain decomposition stage and quantitative indices showed strong correlations with PMI (ρ = 0.61 to − 0.69), with high predictive performance for estimating PMI ≥ 7–60 days (area under the curves [AUCs]: 0.904–0.984). Brain area ratio showed the highest accuracy for estimating PMI ≥ 60 days (AUC = 0.984, cutoff ≤ 60.7 %). The rate of undetermined causes of death increased from 7.1 % in stage 0 to 92.9 % in Stage IV. Brain deformation ratio was positively correlated with seasonal effects (p = 0.0017).

Conclusion

PMCT-based assessment of brain decomposition may provide objective markers for estimating late PMIs and assist in evaluating the likelihood of cause-of-death in decomposed bodies.

背景：准确估计死后时间间隔（PMI）对法医调查至关重要。在死后计算机断层扫描（PMCT）上观察到的脑分解可能为估计PMI提供有用的标记；然而，这种方法还没有得到广泛的研究。本研究的目的是利用PMCT结果对脑分解进行分类和量化，并调查其与PMI、死亡原因的可确定性和环境因素的关系。方法：回顾性分析176例尸检前PMCT病例。使用视觉PMCT结果将脑分解分为五个阶段，并使用轴向计算机断层扫描切片上的脑面积与长度比进行量化。使用相关和回归分析评估PMI与死亡原因可确定性之间的关系。结果：脑分解阶段和定量指标与PMI有较强的相关性（ρ = 0.61 ~ - 0.69），对PMI≥7 ~ 60天具有较高的预测性能（曲线下面积[auc]: 0.904 ~ 0.984）。脑面积比值对PMI≥60天的预测准确率最高（AUC = 0.984，截断值≤60.7%）。未确定死因的死亡率从0期的7.1%上升到4期的92.9%。脑变形率与季节效应呈正相关（p = 0.0017）。结论：基于pmct的脑分解评估可为估计晚期pmi提供客观标记，并有助于评估腐烂尸体的死因可能性。

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引用次数: 0

The role of legal medicine in the reconstruction of fatalities due to tractor rollovers: from evidence to proof 法律医学在重建因拖拉机侧翻死亡事故中的作用：从证据到证据

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-13 DOI: 10.1016/j.legalmed.2025.102711

Ugo Da Broi , Francesco Simonit , Alessio Cappelli , Sirio Cividino , Mauro Zaninelli , Rexson Tse , Jack Garland , Benjamin Ondruschka , Lorenzo Desinan

Despite advances in engineering solutions, such as rollover protective structures and improved operator training, tractor rollovers in agricultural settings continue to be the main cause of death necessitating medicolegal investigations to reconstruct event dynamics and determine causal attributions. This study examines the distinction between evidence (observational data consistent with a hypothesis) and proof (conclusive data confirming a hypothesis) in the context of fatal tractor accidents. We propose a three-phase logic model which provides a conclusive reconstruction of the events by integrating engineering data, dynamic modelling, death scene analysis and autopsy findings. Careful analysis of the death scene and circumstantial evidence is essential during investigations of rollover dynamics, encompassing operational safety procedures, the technical characteristics of the vehicle, corpse position, autopsy findings, toxicology data, the victim’s medical history and psychophysical condition at the time of the accident occurred. Systematizing such variables within a unified forensic framework enhances the scientific reliability of forensic investigations and the technical reconstruction of the fatality, thus contributing to the development of prevention strategies, liability assessment and the formulation of safety policy.

尽管在工程解决方案方面取得了进步，例如侧翻保护结构和改进的操作人员培训，但农业环境中的拖拉机侧翻仍然是导致死亡的主要原因，需要进行法医调查，以重建事件动态并确定因果归因。本研究探讨了致命拖拉机事故背景下证据（与假设一致的观察数据）和证明（确认假设的结论性数据）之间的区别。我们提出了一个三相逻辑模型，该模型通过集成工程数据、动态建模、死亡现场分析和尸检结果，提供了事件的结论性重建。在对翻车动力学进行调查时，必须仔细分析死亡现场和间接证据，包括操作安全程序、车辆的技术特征、尸体位置、尸检结果、毒理学数据、受害者的病史和事故发生时的心理生理状况。在统一的法医框架内将这些变量系统化，可以提高法医调查的科学可靠性和死亡的技术重建，从而有助于制定预防战略、责任评估和制定安全政策。

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引用次数: 0

A pilot study on the relationship between a variable number tandem repeat polymorphism and monoamine oxidase A protein expression in the human brain 可变数串联重复序列多态性与人脑单胺氧化酶A蛋白表达关系的初步研究。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-12 DOI: 10.1016/j.legalmed.2025.102707

Aya Matsusue , Mio Takayama , Naoto Tani , Brian Waters , Masayuki Kashiwagi , Takaki Ishikawa

Monoamine oxidase A (MAOA) catalyzes the oxidative deamination of amine neurotransmitters and xenobiotics. The MAOA gene is located on the X chromosome and has a functional variable number tandem repeat (VNTR) polymorphism of 30 bp repeats in the promoter region (MAOA-uVNTR). The MAOA-uVNTR polymorphism has been associated with transcriptional activity. We herein examined the frequencies of MAOA-uVNTR alleles in 21 cases in which amphetamines or psychotropic drugs were not detected in blood or urine samples (ND cases). We also investigated MAOA protein expression levels in the brains of these cases. In ND cases, brain MAOA expression levels were significantly higher in males with 4-repeat alleles and females who were homozygous for 4-repeat alleles (4 + 4/4 genotype group) than in males with 3-repeat alleles and females who were homozygous for 3-repeat alleles (3 + 3/3 genotype group) (p = 0.0395). Collectively, these results indicate that the MAOA-uVNTR polymorphism affects the brain expression level of MAOA in ND cases.

单胺氧化酶A （MAOA）催化胺类神经递质和异种生物的氧化脱胺作用。MAOA基因位于X染色体上，在启动子区域具有30 bp重复序列的功能性可变数串列重复（VNTR）多态性（MAOA- uvntr）。MAOA-uVNTR多态性与转录活性有关。在此，我们检测了21例血液或尿液样本中未检测到安非他明或精神药物（ND病例）的MAOA-uVNTR等位基因的频率。我们还研究了这些病例大脑中MAOA蛋白的表达水平。在ND病例中，4-repeat等位基因男性和4-repeat等位基因纯合子女性（4 + 4/4基因型组）的脑MAOA表达水平显著高于3-repeat等位基因男性和3-repeat等位基因纯合子女性（3 + 3/3基因型组）（p = 0.0395）。综上所述，这些结果表明MAOA- uvntr多态性影响ND病例中MAOA的脑表达水平。

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引用次数: 0

Comparative analysis of skin microbiome across 10 sites in Koreans for forensic applications: a pilot study 韩国10个地点用于法医应用的皮肤微生物组的比较分析：一项试点研究。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-08 DOI: 10.1016/j.legalmed.2025.102706

Hye-Seon Cho , Ji-woo Lee , Ha-Eun Cha , Jooree Seo , Si-Keun Lim

Various microorganisms have a symbiotic relationship with human skin cells, influenced by intrinsic and extrinsic factors. The composition of the human microbiome varies based on the skin site. To investigate the microbial characteristics of different skin sites in Koreans, microbiome samples were collected from the scalp, forehead, cheek, retroauricular crease, cervical vertebrae, axilla, palm, lateral finger, femur, and plantar skin. The concentrations of human and bacterial DNA were quantified, and QIIME2 and MicrobiomeAnalyst platforms were used for microbial analysis. Forehead and cheek microbiome compositions were similar, with higher proportions of Streptococcus than that at other sites. Palm and lateral finger microbiome compositions were also similar, with higher proportions of Haemophilus than that at other sites. Lawsonella was specifically observed on the scalp, while Mycoplasma was found on cervical vertebrae. Staphylococcus, observed on all sites, was particularly predominant on axilla. The microbial composition of plantar was distinct, with no prevalent genus compared to that at other sites. Further research analyzing skin microbiomes from forensic evidence could help identify the origin of skin samples, aiding in crime scene reconstruction. Comparing our findings from Korean participants with international studies, it suggests that expanding research to include diverse populations could reveal regional and national differences in skin microbiomes, providing valuable insights for forensic science.

多种微生物与人体皮肤细胞存在共生关系，受内在和外在因素的影响。人体微生物组的组成因皮肤部位而异。为了研究韩国人不同皮肤部位的微生物特征，我们从头皮、前额、脸颊、耳后皱褶、颈椎、腋窝、手掌、侧指、股骨和足底皮肤采集了微生物组样本。采用QIIME2和MicrobiomeAnalyst平台进行微生物分析，定量测定人、细菌DNA浓度。额头和脸颊的微生物组成相似，链球菌的比例高于其他部位。手掌和侧指的微生物组成也相似，血友菌的比例高于其他部位。劳索菌主要分布于头皮，支原体主要分布于颈椎。葡萄球菌在所有部位均可见，尤其以腋窝为主。足底微生物组成明显，与其他地点相比，没有流行属。进一步的研究分析来自法医证据的皮肤微生物组可以帮助确定皮肤样本的来源，帮助重建犯罪现场。将韩国参与者的研究结果与国际研究结果进行比较，表明扩大研究范围以包括不同人群可以揭示皮肤微生物组的地区和国家差异，为法医科学提供有价值的见解。

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引用次数: 0

Fatal case of Daisley-Barton Syndrome: A case report with Review of the literature 戴斯利-巴顿综合征致死性1例报告并文献复习

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-06 DOI: 10.1016/j.legalmed.2025.102704

LN. Abisha Tino , Deepu Mathew , Vinod Ashok Chaudhari , P.Keerthi Kumaran , Sanjay Sriram , S. Santhakumar

Daisley-Barton Syndrome is a rare but distinct systemic manifestation of paraquat poisoning, characterized by the development of spontaneous pneumothorax and/or pneumomediastinum. We report the case of an adult male in his 40 s, who presented with abdominal pain and vomiting following ingestion of approximately 200 mL of paraquat. Initial management included gastric lavage and supportive care. Over the following days, he developed mucosal ulcerations involving the lips, tongue, and oral cavity, along with progressive respiratory distress. Imaging revealed pneumothorax and pneumomediastinum. Despite intensive care, the patient died due to respiratory failure. Autopsy revealed extensive pulmonary hemorrhage, necrosis, and diffuse alveolar damage consistent with paraquat toxicity. A literature search was conducted using major databases, and relevant case reports describing Daisley-Barton Syndrome were identified. We compared clinical features, radiological findings, outcomes, and autopsy details, where available. Our case is unique in providing both detailed clinical and autopsy findings. The comparison reinforces the diagnostic significance of spontaneous pneumothorax and pneumomediastinum as hallmark features of the syndrome and highlights the variability in clinical course and outcomes. This report emphasizes the importance of early recognition and the role of autopsy in confirming diagnosis and understanding the underlying pathophysiology.

戴斯利-巴顿综合征是一种罕见但明显的百草枯中毒全身性表现，以自发性气胸和/或纵隔气肿为特征。我们报告的情况下，在他的40多岁的成年男性，谁提出腹痛和呕吐后摄入约200毫升百草枯。最初的治疗包括洗胃和支持性护理。在接下来的几天里，他出现了包括嘴唇、舌头和口腔的粘膜溃疡，并伴有进行性呼吸窘迫。影像学显示气胸和纵隔气。尽管经过重症监护，病人还是死于呼吸衰竭。尸检显示广泛的肺出血、坏死和弥漫性肺泡损伤与百草枯中毒一致。使用主要数据库进行文献检索，找到描述Daisley-Barton综合征的相关病例报告。我们比较了临床特征、放射学表现、结果和尸检细节。我们的病例在提供详细的临床和尸检结果方面是独一无二的。该比较强调了自发性气胸和纵隔气肿作为该综合征的标志性特征的诊断意义，并强调了临床过程和结果的可变性。本报告强调了早期识别的重要性和尸检在确诊和理解潜在病理生理方面的作用。

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引用次数: 0

Differences between accidents and suicides in river drowning cases based on forensic autopsy information in a part of Japan 基于日本部分地区法医尸检信息的河中溺水事故与自杀的差异

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-06 DOI: 10.1016/j.legalmed.2025.102705

Kurumi Kokusho , Ayako Himemiya-Hakucho , Izumi Takase

Background

The number of drowning deaths worldwide is increasing, and preventive measures are being developed on a global scale. However, unlike the global trend, elderly people account for most drowning deaths in Japan, which suggests that unique surveys and measures are required. In this study, we analyzed forensic autopsy cases of river drowning in a part of Japan to reveal the characteristics of the deaths and of finding of the deceased.

Methods

We retrospectively investigated river drowning cases for which a forensic autopsy was performed from 2012 to 2021 in Yamaguchi Prefecture, Japan. Various factors were examined statistically for comparison of accidents and suicides.

Results

The accident group tended to be older and many had cognitive impairments or reduced mobility, while the suicide group tended to be younger, with a higher proportion in their 50 s and 60 s. Many cases in both groups occurred within 6 h of the last confirmed contact. The suicide cases were reported as missing more frequently than the accident cases. The accident cases tended to occur in smaller, more familiar rivers, while suicide cases tended to occur in larger rivers further from home. Preventive measures such as guardrails or fences were present in 81.8 % of the suicide cases and 22.0 % of the accident cases.

Conclusions

This study highlights the importance of timely searches, innovative preventive measures, and societal awareness focused on people with mental and cognitive problems to address the underlying factors contributing to drowning in rivers due to accident and suicide in Japan.

背景全世界溺水死亡人数正在增加，目前正在全球范围内制定预防措施。然而，与全球趋势不同的是，在日本，老年人占溺水死亡的大多数，这表明需要进行独特的调查和措施。在本研究中，我们分析了日本部分地区河流溺水的法医尸检案例，以揭示死亡和发现死者的特征。方法回顾性调查2012年至2021年日本山口县进行法医尸检的河流溺水病例。为了比较事故和自杀，对各种因素进行了统计检查。结果事故组年龄偏大，许多人有认知障碍或行动能力下降，而自杀组年龄偏小，50 - 60岁的比例较高。两组中的许多病例发生在最后一次确诊接触后6小时内。据报道，自杀案件比事故案件失踪的频率更高。事故案件往往发生在更小、更熟悉的河流中，而自杀案件往往发生在离家更远的大河中。81.8%的自杀个案及22.0%的意外个案均设有护栏或围篱等预防措施。本研究强调了及时搜索，创新预防措施以及关注精神和认知问题人群的社会意识对于解决导致日本因事故和自杀而在河流中溺水的潜在因素的重要性。

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引用次数: 0

Current major problems with the establishment of effective measures to prevent suicide among children in Japan: Collaborative studies between legal medicine and public health are needed to address these problems 目前在制定防止日本儿童自杀的有效措施方面存在的主要问题：需要在法律医学和公共卫生之间进行合作研究，以解决这些问题

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-05 DOI: 10.1016/j.legalmed.2025.102701

Ken Inoue , Tadashi Takeshima , Takashi Yamauchi , Tsukasa Sasaki , Yuri Murayama , Sultana Razia , Haruo Takeshita , Noriyuki Kawano , Tatsushige Fukunaga

The number of suicides by children in Japan has increased over the past few years. We conducted this descriptive epidemiological study to identify aspects of this situation that must be improved. We summarize the observations based on our findings and describe effective approaches to decrease the number of suicides among children. We investigated and calculated the number of suicides and the percentage of ’unknown’ causes of/motives for suicide among the categories of causes of/motives for suicide among Japanese elementary, junior high school, and high school students (including separate analyses for male and female students) during the 3-year period 2022–2024 based on the numerical data published by Japan’s Ministry of Health, Labour and Welfare and the National Police Agency. The current problems with suicide statistics are explained, and potential approaches to dealing with these statistics are described. During the 3-year study period, 1,556 suicides by elementary, junior high school, and high school students were recorded in Japan. ’Unknown’ causes of/motives for suicide accounted for 11.8% of the suicides by the students overall during the 3-year period; the yearly percentage for these unknown causes was 10.1%–12.9%. Since Japan’s Status of Suicide report was revised in 2022, care is required when comparing suicide data with the data obtained before 2022. These issues must be addressed in collaborations by legal medicine and public health experts.

过去几年，日本儿童自杀的数量有所增加。我们进行了这项描述性流行病学研究，以确定这种情况中必须改善的方面。我们根据我们的发现总结了观察结果，并描述了减少儿童自杀数量的有效方法。根据日本厚生劳动省和国家警察厅公布的数字数据，我们调查并计算了日本小学、初中和高中学生在2022-2024年的3年间自杀人数和自杀原因/动机类别中“未知”自杀原因/动机的百分比（包括对男性和女性学生的单独分析）。解释了目前自杀统计的问题，并描述了处理这些统计的潜在方法。在为期3年的研究期间，日本记录了1556名小学生、初中生和高中生自杀事件。在3年期间，“未知”自杀原因/动机占学生自杀总数的11.8%；这些未知原因每年的百分比为10.1%-12.9%。由于日本的自杀状况报告于2022年进行了修订，因此在将自杀数据与2022年之前获得的数据进行比较时需要小心。这些问题必须由法律医学和公共卫生专家合作解决。

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引用次数: 0

Can intramuscular hemorrhage in the back be detected on postmortem CT? A forensic study in drowning cases 死后CT能发现背部肌肉内出血吗？溺水案件的法医研究

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2025-09-05 DOI: 10.1016/j.legalmed.2025.102702

Shogo Shimbashi , Motoo Yoshimiya , Akiko Tashiro , Shunsuke Sakamoto , Hideki Hyodoh

An intramuscular hemorrhage in the back is considered a potential supportive finding with regard to diagnosing drowning; however, its detection traditionally requires autopsy. This study aimed to evaluate whether back muscle intramuscular hemorrhage can be reliably identified on postmortem computed tomography (PMCT). Here, we retrospectively reviewed 31 drowning cases for which autopsies had already been performed, comparing PMCT scans acquired before dissection with the subsequent autopsy findings. Intramuscular hemorrhage in 11 major back muscles was recorded and compared with the PMCT findings; furthermore, diagnostic accuracy (sensitivity, specificity, and F1 score) was calculated. Of the 682 muscles, 176 (25.8 %) showed hemorrhage on autopsy. Overall, the PMCT sensitivity was 21.6 %, specificity was 92.1 %, and F1 score was 0.299. ROC analysis showed that hemorrhages larger than certain size thresholds (6.0 and 4.5 cm in vertical and horizontal dimensions, respectively, with 16.0 cm² area) were more likely to be detected. Detection improved with the increase in hemorrhage size; however, many smaller lesions were missed. While large hemorrhages can occasionally be recognized on PMCT, routine forensic applications for detecting back muscle hemorrhages remain limited. PMCT often underestimates the incidence of smaller intramuscular hemorrhages. Meticulous autopsy remains indispensable for the accurate diagnosis of intramuscular hemorrhage in drowning cases.

背部肌肉内出血被认为是诊断溺水的潜在支持发现；然而，它的检测传统上需要尸检。本研究旨在评估死后计算机断层扫描（PMCT）是否可以可靠地识别背部肌肉内出血。在这里，我们回顾性地回顾了31例已经进行尸检的溺水病例，将解剖前获得的PMCT扫描与随后的尸检结果进行了比较。记录11个主要背部肌肉的肌内出血，并与PMCT结果进行比较；此外，计算诊断准确性（敏感性、特异性和F1评分）。682块肌肉中，尸检时发现有176块（25.8%）出现出血。总体而言，PMCT敏感性为21.6%，特异性为92.1%，F1评分为0.299。ROC分析显示，大于一定尺寸阈值（垂直和水平尺寸分别为6.0 cm和4.5 cm，面积为16.0 cm2）的出血更容易被发现。随着出血大小的增加，检出率提高；然而，许多较小的病变被遗漏。虽然在PMCT上偶尔可以识别出大出血，但常规的法医应用来检测背部肌肉出血仍然有限。PMCT常常低估较小的肌内出血的发生率。细致的解剖仍然是必不可少的准确诊断肌肉内出血溺水案件。

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引用次数: 0