The multidetector CT finding of frothy airway fluid or high-attenuation airway sediment is highly suggestive of drowning; multidetector CT findings of pan sinus fluid, mastoid cell fluid, subglottic tracheal and bronchial fluid, and ground-glass opacity within the lung at multidetector CT are supportive of drowning in the appropriate scenario.

Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.

This study compared autopsy with postmortem multidetector computed tomography (MDCT) findings in charred remains. Seventeen consecutive male subjects (mean age, 29.4 years) who perished in a fire-related event resulting in charred remains underwent total body MDCT immediately prior to routine autopsy that included serum carboxyhemoglobin measurement. MDCT showed all thermal tissue changes (skin and subcutaneous fat loss, skeletal muscle retraction, pugilistic attitude, cortical fractures, bone and organ destruction, thermal epidural hematoma, and thermal amputation) and established all fracture patterns that were lethal, but autopsy added the fire as a contributory cause of death when there was carboxyhemoglobin elevation. MDCT had limited value in determination of lethal vascular and visceral injuries. MDCT is an effective complement to autopsy in the setting of charred remains and may serve to augment a limited autopsy. This may be particularly useful in mass casualty scenarios.

Needle thoracentesis is an emergency procedure to relieve tension pneumothorax. Published recommendations suggest use of angiocatheters or needles in the 5-cm range for emergency treatment. Multidetector computed tomography scans from 100 virtual autopsy cases were used to determine chest wall thickness in deployed male military personnel. Measurement was made in the second right intercostal space at the midclavicular line. The mean horizontal thickness was 5.36 cm (SD = 1.19 cm) with angled (perpendicular) thickness slightly less with a mean of 4.86 cm (SD 1.10 cm). Thickness was generally greater than previously reported. An 8-cm angiocatheter would have reached the pleural space in 99% of subjects in this series. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length.

MDCT may guide, direct, or limit forensic autopsy in projectile injury cases, thereby eliminating the need for a complete invasive autopsy.