American Journal of Forensic Medicine and Pathology最新文献

Predation by domestic pigs is unusual but not unheard of. However, predation by a herd of pigs is rare and has not been previously reported in the literature. We present a case report of an individual with predation by a herd of domestic pigs. The case involved a woman who had collapsed from a ruptured saccular aneurysm on her farm. A herd of farm pigs had subsequently predated on the decedent, either while she was unconscious (perimortem), or after death (postmortem). The features of the predation are described, showing characteristics previously described in individual porcine attacks on the living and documented in forensic taphonomy, albeit with rapidity not previously reported. Postulations of why the predation had occurred in a normally docile herd of pigs are discussed, including the status of the herd, familiarity between the herd and the decedent, and the decedent's activity around the time of death. Forensic implications of a rural death scene are also discussed in brief.

Central nervous system (CNS) tumors, though relatively uncommon in the general population, frequently cause significant morbidity and mortality in those affected. Although high-grade neoplasms specifically may prove rapidly fatal, the rarity of these neoplasms-as well as their nonspecific symptomatology-renders them easily mistaken for both more common and innocuous etiologies. We report a case of a 38-year-old female with no significant medical history who sought care after 1 week of blurred vision and pressure-like headache worsened by leaning forward. Following antibiotic and oral steroid therapy for suspected acute sinusitis, she was found dead at home 3 weeks later. Autopsy revealed a 4.5-cm hemorrhagic and necrotic mass arising around and essentially effacing the third ventricle, further obstructing the cerebral aqueduct and causing bihemispheric mass effect. Histologic and immunohistochemical workup demonstrated a high-grade IDH-wildtype diffuse glioma. In this report, we review the uncommon clinical circumstance in which untreated intracranial neoplasms can prove rapidly fatal, salient clinical examination features to recognize such a condition, and the suggestions and limitations of leading neuroimaging criteria and guidelines for patients presenting with headaches.

One important way to ensure quality and standardization of medicolegal death investigation is medical examiner/coroner (ME/C) office accreditation. The two existing accrediting bodies for ME/C offices (National Association of Medical Examiners and International Association of Coroners and Medical Examiners) both specify autopsy caseload limits as part of accreditation standards; however, no such benchmark staffing number exists for medicolegal death investigators (MDI) in office accreditation standards. This pilot study assesses which model for MDI staffing is preferred as an accreditation item, subjective job stressors, typical MDI job tasks, and whether other "workload" complexity factors should be considered for MDI staffing in future accreditation standards. Results from 333 total respondents in an online questionnaire show: (1) the vast majority favor MDI workload standards, (2) the majority indicate the standards should be based on either jurisdiction population, the number of cases investigated by the office, or by the number of ME/C deaths in the jurisdiction, (3) MDI jobs require "extensive mental effort," (4) MDIs have feelings of workplace anxiety, stress, and a marked need for situational self-control, and (5) workload considerations for indirect investigative activities and individual case complexity for non-natural deaths should be considered when developing MDI workload staffing standards.

This previously healthy 6-month-old boy presented with sudden collapse under the care of his mother while feeding. Despite immediate resuscitation, the infant suffered a prolonged period of hypoxic-ischemic injury. Upon admission to the hospital, a CT head scan revealed a large, mixed-density left frontal subdural hemorrhage causing significant mass effect, as well as features of global hypoxic-ischemic injury. Fundoscopic examination revealed bilateral retinal hemorrhages that were "too numerous to count." Since the articulated clinical history was not deemed to account for the boy's condition, a diagnosis of "abusive head trauma" was suspected, and the parents were removed from the custody of the boy's living twin. Prognosis was considered poor, resulting in care being withdrawn. The infant succumbed 2 days following presentation. Autopsy revealed a large, ruptured, left frontal meningeal arteriovenous fistula. In contrast to the fundoscopic impression, autopsy examination revealed only mild retinal hemorrhage limited to the posterior poles of the globes, suggesting an etiology attributable to raised intracranial pressure. Upon issuance of the autopsy report, the parents regained custody of the second twin. This case adds to the extensive literature arguing against the contention that the so-called "triad" (ie, subdural hemorrhage, retinal hemorrhage, and encephalopathy) is pathognomonic for shaken baby syndrome.

Thallium was widely used as a rat poison, but because of its high toxicity, it was banned from the market. Due to these limitations, its use for homicidal purposes has become a rare event over the years, and the biological signs of this fatal poisoning remain unclear and elusive, similar to the histologic lesions it induces. For this reason, we valuated it appropriate to report a specific and targeted focus on the microscopic pictures of this poisoning, given the uniqueness of the forensic case brought to our attention. In fact, not only were they 3 subjects who died of homicidal thallium poisoning, but also with different survivals, which made it possible to investigate the short and medium-term effects, currently completely unknown in the literature. In particular, both the signs related to the gastrointestinal transit of the toxic substance and the systemic ones due to its metabolization were documented, focusing mainly on viscera with high functional dignity and fully justifying the death of the victims. We therefore present the microscopic evidence that has emerged and discuss its forensic relevance, associating a complete and broad iconography, with the aim of enriching knowledge on this specific topic that is still little explored.

Group A Streptococcus (GAS) is a gram-positive bacterium that causes a spectrum of illnesses, ranging from mild infections such as pharyngitis and impetigo to severe invasive diseases, including necrotizing fasciitis, streptococcal toxic shock syndrome, sepsis, and septic shock. Surveillance data from the United States and Europe indicate a marked post-COVID-19 pandemic increase in invasive GAS infections. At the Cook County Medical Examiner's Office (CCMEO), a retrospective review (2015-2025) identified 26 fatal GAS cases, with a significant surge in the postpandemic period. Postmortem diagnosis relies on cultures from sterile sites and histologic examination to confirm infection and minimize contamination artifacts. Most cases demonstrated rapid clinical progression, underscoring the high lethality of invasive GAS. As a secondary objective, postmortem pharyngeal swabs were collected in pediatric cases with suspected GAS infection and tested using a rapid antigen assay; all results were negative and confirmed by culture. These findings suggest the test may be useful for ruling out infection in negative cases, though the sensitivity in confirmed positives remains undetermined. This study highlights the essential role of forensic pathologists in detecting and documenting invasive GAS infections, thereby supporting public health surveillance, outbreak monitoring, and preventive strategies. Prompt recognition, accurate diagnostic sampling, and sustained vigilance are critical to reducing morbidity and mortality from this pathogen.

Perinatal deaths [including fetal death (FD), miscarriage, stillbirth, and early neonatal death (ENND)] referred for forensic investigation are often complex and can involve medical, biological, traumatic, toxicological, and psychosocial components. Further complicating these deaths is the regional and national heterogeneity of statutory requirements, practice conventions, and access to resources. This inconsistency affects the quality of national data and may impact mothers and families by potential criminal prosecution and/or loss of parental rights. Thus, the National Association of Medical Examiners (NAME) convened an expert panel to create a position paper regarding the investigation of perinatal deaths. This paper provides evidence-based guidance to medical examiners, coroners, and death investigators regarding the investigation and certification of perinatal deaths, with specific focus on the settings of maternal substance use disorder and making the determination of live birth versus stillbirth.

The New York City (NYC) Office of Chief Medical Examiner (OCME) continues to be severely impacted by the ongoing opioid overdose crisis with over 3000 overdose deaths in 2022 alone. The National Association of Medical Examiners (NAME) recommends that autopsies be performed in all suspected overdose deaths, but this practice is difficult to maintain in the face of an unprecedented number of overdose deaths and a national shortage of forensic pathologists. Using an existing database of suspected overdose deaths (SPOT) maintained by the OCME Drug Intelligence and Intervention Group (DIIG), we sought to assess the ability to correctly certify subsets of suspected overdose deaths based only on known history and circumstances, external examination, and toxicology testing (View-Tox) using 6 exclusionary criteria for View-Tox eligibility (suspicion of criminality, suicide, trauma, hypothermia/drowning, epilepsy/seizures, and death in a public location). This process resulted in the exclusion of all homicides, suicides, non-overdose accidents, and most undetermined manner deaths. Of the remaining cases eligible for View-Tox, 99.2% could be correctly certified based only on toxicology testing results and information known before autopsy. This approach to overdose deaths would have resulted in a 32.8% reduction of autopsies in suspected overdose deaths at OCME in 2022.

In this issue of "The Scalpel Is Passed," I have the pleasure of interviewing Professor Peter Knudsen, a Danish forensic pathologist with over 35 years of experience, including work as a member of the DVI team in Kosovo and Thailand. I met Professor Knudsen many years ago in Lyon at a ballistics conference. We've stayed in touch ever since, and I occasionally have the pleasure of meeting him at conferences and scientific workshops, never missing an opportunity to chat with him and benefit from his extensive and comprehensive knowledge of forensic medicine and beyond.