The gas bubble sign—a reliable indicator of laryngeal fractures in hanging on post-mortem CT

Schulze, Katja; Ebert, Lars C.; Ruder, Thomas D.; Fliss, Barbara; Poschmann, Sebastian Alexander; Gascho, Dominic; Thali, Michael J.; Flach, Patricia M.

doi:10.1259/bjr.20170479

Cited by 28 publications

(18 citation statements)

References 26 publications

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“…These results suggest that other studies aiming to evaluate the correlation between adrenal β2-AR expression and the activation of SA system and HPA axis (not investigated in the present study) could be very useful to improve the knowledge of stress response processes. Furthermore, in a medicolegal approach to the causes and mechanisms of death, adrenal gland analysis could prove to be, as well as other second level investigations [50,51,52,53,54,55,56], a useful tool to improve the etiopathogenetic assessment of stress-related death.…”

Section: Discussionmentioning

confidence: 99%

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

Spagnolo

Mondello

Cardia

et al. 2019

IJMS

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The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal β2-adrenergic receptor (β2-AR), a receptor with high-affinity for catecholamines, with the aim to show which zones it is expressed in and how its expression differs in relation to the cause of death. The immunohistochemical study was performed on adrenal glands obtained from 48 forensic autopsies of subjects that died as a result of different pathogenic mechanisms using a mouse monoclonal β2-AR antibody. The results show that immunoreactivity for β2-AR was observed in all adrenal zones. Furthermore, immunoreactivity for β2-AR has shown variation in the localization and intensity of different patterns in relation to the original cause of death. To the best of our knowledge, this is the first study that demonstrates β2-AR expression in the human cortex and provides suggestions on the possible involvement of β2-AR in human cortex hormonal stimulation. In conclusion, the authors provide a possible explanation for the observed differences in expression in relation to the cause of death.

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Section: Discussionmentioning

confidence: 99%

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

Spagnolo

Mondello

Cardia

et al. 2019

IJMS

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“…The PMCT as a noninvasive supplement to traditional autopsy can reveal small but relevant findings, which may go undetected during the external examination of the body or during autopsy. [17][18][19][20][21][22] A nasal septum defect may be such a finding, as clinical examination of the nose and the nasal cavities may be difficult, especially in cases of advanced decomposition with maggots' infestation or cases of severe facial trauma. The PMCT can easily and quickly reveal septal defects and allows further detailed investigation of its characteristics, like its edges' morphology and the presence of insects in the region.…”

Section: Discussionmentioning

confidence: 99%

Nasal Septum Defects Detected on Postmortem Computed Tomography

Chatzaraki

Schweitzer

Thali

et al. 2019

Am J Forensic Med Pathol

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Nasal septum defects may have forensic relevance because they are associated with various mechanisms, including trauma and cocaine abuse. Like all human body tissues, the nasal septum may be affected by maggots' infestation during postmortem decomposition. Postmortem computed tomography (PMCT) can reveal small findings and related details. Three cases of early postmortem period and 2 cases of advanced decomposition, where external examination of the nasal cavities and PMCT revealed nasal septum defect, are presented. In the early postmortem period cases, the lesions' edges appeared smoother on PMCT, whereas in the advanced decomposed cases, the edges were irregular and maggots were infested. Postmortem computed tomography can detect nasal septum defects and may help differentiate the preexisting from the postmortem ones based on their edges' radiological appearance. Such findings may indicate possible chronic cocaine abuse (cocaine nose), trauma, or other nasal pathology. It is important to note that such defects may be altered or caused by advanced decomposition.

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“…Two radiologists evaluated all images retrospectively, and discrepancies were discussed with the goal of achieving concordance. Predetermined findings were the presence of a strangulation mark, laryngeal fractures, skull and cervical spine fractures, the gas bubble sign, 23 hemorrhages and brain edema, and brain hemorrhages. The thorax and abdomen CT images were assessed concerning lung and soft tissue emphysema.…”

Section: Radiological Assessmentmentioning

confidence: 99%

“…In addition to CT, we analyzed all MRI examinations focusing on hemorrhages. The presence of skull, cervical spine, and laryngeal fractures as well as previously described fracture-related gas bubbles were assessed on CT. 3,23 In addition, we evaluated brain hemorrhages and brain edema on both modalities, which were deemed a potential indicator for the severity of premortal damage. 24 For a complete overview, we verified the presence of soft tissue and lung emphysema as well as pneumomediastinum on CT. 8,25,26…”

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confidence: 99%

Postmortem Magnetic Resonance Imaging and Postmortem Computed Tomography in Ligature and Manual Strangulation

Deininger‐Czermak

Heimer

Tappero

et al. 2020

Am J Forensic Med Pathol

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The aim of this study was to evaluate magnetic resonance imaging (MRI) findings in cases of fatal manual or ligature strangulation. Verification of strangulation by computed tomography (CT), MRI, and at autopsy as well as its detectability in each modality was assessed. METHODS:We retrospectively analyzed 6 manual and ligature strangulation cases between 2013 and 2019 who all underwent a whole-body CT, head and neck MRI, and an autopsy. Two radiologists examined head and neck imaging data and compared the data to autopsy findings. RESULTS:Magnetic resonance imaging showed a high efficiency in verifying intramuscular hemorrhages, which were confirmed in autopsy. Moreover, in one case without a visible strangulation mark, soft tissue injuries associated with strangulation were detected. Fractures, especially thyroid cartilage fractures, were successfully diagnosed by CT. CONCLU-SIONS:As MRI showed a successful detection of soft tissue lesions in relation to strangulation, it can serve as an alternative method or provide additional value to an autopsy. Intramuscular hemorrhages are a common finding in manual and ligature strangulation, providing a useful sign of applied pressure on the neck. However, to evaluate fractures, an additional CT or autopsy is recommended.

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The gas bubble sign—a reliable indicator of laryngeal fractures in hanging on post-mortem CT

Cited by 28 publications

References 26 publications

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

Nasal Septum Defects Detected on Postmortem Computed Tomography

Postmortem Magnetic Resonance Imaging and Postmortem Computed Tomography in Ligature and Manual Strangulation

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