Cardiovascular IgG4-related disease (IgG4-RD) is a rare and potentially lethal condition that may remain entirely clinically silent until sudden death occurs. We report a forensic autopsy case of extensive cardiovascular IgG4-RD involving the ascending aorta, pericardium, coronary arteries and the intrinsic cardiac nerve plexuses a finding, that, to the best of our knowledge, has not been previously reported in cardiovascular IgG4-RD. A complete forensic autopsy was performed, including comprehensive gross examination of the heart and great vessels. Histopathological evaluation and immunohistochemical staining (IgG4 and IgG) were undertaken. The diagnosis was established according to the 2019 American College of Rheumatology/European League Against Rheumatism classification criteria. The autopsy demonstrated diffuse fibroinflammatory involvement of multiple cardiovascular structures, including the ascending aorta, the pericardium, coronary arteries, myocardium, and intrinsic cardiac nerve plexuses. Histological examination revealed dense lymphoplasmacytic infiltrates with storiform fibrosis and abundant IgG4-positive plasma cells at all affected sites, with a maximum count of 32 IgG4- positive cells plasma cells per high power field (HPF) and an IgG4/IgG ratio exceeding 40
Purpose: Estimating the postmortem interval (PMI) is a critical component of forensic investigations. Refrigeration is routinely used to slow or halt decomposition prior to autopsy; however, its impact on PMI estimation using total body score (TBS) and entomological methods remains insufficiently understood. Methods: This study used ten domestic pig (Sus scrofa domesticus) carcasses (20–40 kg) decomposed under controlled conditions. Two controls were included: one remained unrefrigerated for 17 days and one refrigerated for 17 days. Eight experimental carcasses decomposed subaerially for 4, 7, 10, or 13 days before being refrigerated for four days, simulating standard forensic practice. Daily TBS, body and ambient temperatures, and accumulated degree days were recorded. PMI estimates were calculated at the end of both the subaerial and refrigeration periods using TBS and entomological approaches. Results: PMI estimates were most accurate when calculated prior to refrigeration, with 100
In forensic practice, sudden maternal deaths following obstetric procedures require meticulous postmortem investigation to establish the cause of death. Although pregnancy termination is generally considered a safe procedure, rare but potentially fatal complications may occur. Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome and venous air embolism are individually uncommon but life-threatening conditions. A 23-year-old woman (gravida 2, para 1) at 9 weeks and 6 days of gestation underwent an uncomplicated elective pregnancy termination following normal preoperative laboratory findings. Within a few hours after the procedure, she developed gastrointestinal symptoms, hypotension, rapidly progressive thrombocytopenia, elevated liver enzyme levels, and laboratory evidence of hemolysis. Despite intensive resuscitative efforts, she died. A meticulous medico-legal autopsy employing the underwater pericardial water-filling technique demonstrated abundant intracardiac air within the right ventricle, while the overall clinical and laboratory findings supported the diagnosis of HELLP syndrome. This case highlights the fatal coexistence of early-onset HELLP syndrome and venous air embolism following first-trimester pregnancy termination. It underscores the importance of comprehensive clinicopathological correlation and meticulous forensic autopsy in accurately determining the cause of unexplained maternal death. The fatal co-occurrence of early-onset HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome and venous air embolism following first-trimester pregnancy termination is an exceptionally rare clinical event. The microangiopathic and hemodynamic instability associated with early-onset HELLP syndrome may lower the physiological threshold for fatal cardiovascular collapse following venous air entry. Performing the underwater pericardial water-filling test prior to manipulating great vessels is essential to unequivocally confirm air embolism and exclude postmortem artifacts. Medico-legal cause-of-death determination in sudden maternal deaths requires an integrated synthesis of clinical trajectories, postmortem imaging, and targeted histopathology.
Accurate injury documentation is essential in forensic medicine, however conventional two-dimensional imaging methods are limited in their ability to capture spatial morphology and enable retrospective three-dimensional (3D) reassessment. Although multicamera photogrammetry has significantly advanced forensic surface documentation, challenges remain when imaging with low texture, homogeneous coloration, or reflective properties. This study presents an integrated workflow combining multicamera photogrammetry with projection-assisted acquisition using a digital spray mode to improve surface reconstruction under optically challenging conditions. Technical feasibility was evaluated using a handbag, a mannequin, and a voluntary participant with simulated injuries applied as adhesive tattoos, acquired using the Botspot full-body scanner NEO system. The workflow generated anatomically coherent full-body 360° models with high-fidelity texture representation, enabling clear visualization, identification and retrospective 3D measurement of simulated injuries. Compared with conventional passive acquisition, the digital spray mode improved reconstruction completeness and feature-matching stability. These findings demonstrate the feasibility of integrating enhanced acquisition techniques with advanced visualization methods in a unified forensic workflow and highlight the potential of non-contact projection-assisted technologies for documenting optically challenging surfaces, including visually homogeneous or reflective regions of human skin, without requiring physical surface treatment that could interfere with forensic evidence. In addition, image datasets acquired within this workflow were processed using 3D Gaussian Splatting (3DGS), a radiance field-based rendering method enabling efficient real-time rendering and high-fidelity visualization of reconstructed scenes. While current 3DGS representations are primarily optimized for visualization rather than metrically validated surface reconstruction, the technique demonstrates considerable potential for future forensic applications, particularly in interactive documentation, immersive case review, and advanced 3D visualization workflows. Projection-assisted digital spray acquisition improves photogrammetric reconstruction stability and geometric completeness on optically challenging forensic surfaces. The integrated multicamera workflow enables rapid full-body 3D documentation with realistic texture representation and retrospective morphometric injury assessment. Separation of geometry acquisition and texture capture allows optimization of reconstruction quality while preserving natural visual appearance. Digital spray technology enhances feature matching without physical surface treatment, thereby avoiding potential alteration of forensic evidence. 3D Gaussian Splatting enables highly photorealistic real-time visualization and immersive forensic review workflows, although current implementations remain limited for precise metric measurements.
Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal adverse reaction to antipsychotic and other dopamine-modulating medications and remains one of the most challenging diagnoses in forensic pathology. Postmortem findings are typically nonspecific and toxicological analyses often demonstrate therapeutic drug concentrations; therefore, accurate cause-of-death determination requires integrated medico-legal evaluation. A retrospective forensic case series was evaluated using the national forensic death investigation system of the Council of Forensic Medicine of Türkiye. First Forensic Medicine Board (FFMB) reports between 2013 and 2024 (n = 53,677) obtained via the National Judiciary Informatics System (UYAP) were screened. Cases in which NMS or malignant hyperthermia was considered underwent detailed manual review, and only those in which the FFMB established NMS or malignant hyperthermia as the final cause of death were included. Demographic characteristics, medication exposure, clinical course, laboratory investigations, autopsy findings, histopathology, toxicological analyses, and final forensic determinations were systematically evaluated. Seventeen deaths met the inclusion criteria, of which fourteen deaths were attributed to NMS associated with antipsychotic therapy and three deaths were attributed to anesthesia-related malignant hyperthermia. Most NMS decedents had underlying psychotic disorders and were receiving antipsychotic treatment, frequently in the setting of psychotropic polypharmacy or depot formulations. A recurring clinical pattern of hyperthermia, neuromuscular abnormalities, altered mental status, autonomic instability, and marked creatine kinase elevation was observed. Autopsy findings were predominantly nonspecific, most commonly demonstrating visceral congestion and pulmonary edema. Toxicological analyses identified prescribed psychotropic medications at therapeutic or near-therapeutic concentrations without evidence of lethal intoxication. Final cause-of-death determination relied on integrated forensic evaluation and systematic exclusion of competing hyperthermic syndromes. Fatal NMS represents a diagnostically challenging functional drug-related cause of death for which neither autopsy nor toxicological analysis alone is sufficient. Accurate forensic diagnosis requires comprehensive integration of clinical history, medication exposure, laboratory investigations, autopsy findings, toxicological results, and exclusion of competing hyperthermic syndromes. Recognition of these recurring clinical and forensic patterns may facilitate more accurate medico-legal cause-of-death determination in suspected NMS-related deaths. Fatal neuroleptic malignant syndrome lacks specific postmortem findings but should be considered despite nonspecific autopsy and histopathological features. Therapeutic postmortem concentrations of psychotropic medications do not exclude neuroleptic malignant syndrome as the cause of death. Recurring clinical features such as hyperthermia, neuromuscular dysfunction, altered mental status, autonomic instability, and elevated creatine kinase provide important diagnostic clues when interpreted together with forensic findings. Accurate forensic diagnosis requires integrated multidisciplinary evaluation of the clinical course, medication exposure, laboratory investigations, autopsy findings, toxicological analyses, and the exclusion of competing hyperthermic syndromes.
Syphilis, a chronic sexually transmitted infection caused by Treponema pallidum, has become a rare cause of death in the antibiotic era when diagnosed and treated promptly. Nevertheless, severe and fatal complications may still occur in vulnerable populations. We report the case of a 45-year-old imprisoned intravenous drug user who died following acute neuroinflammation most likely associated with neurosyphilis. The patient was admitted with loss of consciousness and generalized tonic–clonic seizures. Medical records documented a diagnosis of neurosyphilis established five months earlier, while cerebrospinal fluid analysis demonstrated inflammatory changes consistent with central nervous system involvement. Despite anticonvulsive and antibiotic therapy, he died shortly after admission. Autopsy revealed mild cerebral edema and cloudy leptomeninges. Histopathological examination demonstrated chronic lymphoplasmacytic meningoencephalitis with perivascular inflammatory infiltrates, leptomeningeal inflammation, gliosis, neuronal loss, and chronic vascular changes. Warthin–Starry staining and immunohistochemistry for Treponema pallidum were negative. Although these findings were compatible with neurosyphilis, they were not pathognomonic. In the absence of complete clinical documentation and comprehensive ancillary investigations, the diagnosis was based on integration of the available clinical history, autopsy, histopathological, and toxicological findings, together with exclusion of more likely alternative causes. This case highlights the diagnostic challenges of postmortem evaluation of suspected neurosyphilis and emphasizes the importance of cautious clinicopathological correlation in forensic practice, particularly when supporting diagnostic investigations are incomplete. Syphilis remains a globally relevant systemic infection despite the availability of effective antibiotic therapy. Neurosyphilis may occur at different stages of infection and often presents with nonspecific neurological manifestations. This report describes a fatal neuroinflammatory disease in a high-risk prisoner with a documented history of neurosyphilis. Histopathological findings were compatible with neurosyphilis but were not pathognomonic, highlighting the importance of differential diagnosis. Postmortem diagnosis relied on clinicopathological correlation and exclusion of more likely alternative causes, emphasizing the challenges of diagnosing suspected neurosyphilis in forensic practice.
Aluminium phosphide is a widely used fumigant pesticide that releases phosphine (PH₃), a highly toxic gas responsible for severe and often fatal poisoning. Phosphine intoxication is characterized by rapid clinical deterioration, severe metabolic acidosis, cardiovascular collapse, and multiorgan failure. From a forensic perspective, the diagnosis may be challenging because autopsy findings are frequently nonspecific. We report a fatal case of phosphine poisoning following accidental exposure to aluminium phosphide (Phostoxin) in a 41-year-old electrician. Clinical, biochemical, autopsy, and toxicological findings were analyzed, with particular emphasis on classical qualitative toxicological methods. The patient collapsed at his workplace after entering a recently fumigated storage facility, resulting in accidental inhalation of phosphine gas. Laboratory investigations revealed severe metabolic acidosis (pH 6.81) with markedly elevated lactate concentrations (up to 25 mmol/L), indicating profound mitochondrial dysfunction. Biochemical findings demonstrated rapid progression of multiorgan failure, including severe myocardial injury, hepatic damage, renal failure, and coagulation abnormalities consistent with disseminated intravascular coagulation. Despite intensive treatment, the patient died 37 h after hospital admission. Forensic autopsy revealed nonspecific findings, including organ congestion and edema, while histological examination was limited by extensive postmortem autolysis. Toxicologicalanalysis of postmortem samples confirmed the presence of phosphine using classical qualitative reactions, including the silver nitrate and ammoniummolybdate tests. This case highlights the diagnostic challenges associated with phosphine poisoning and emphasizes the importance of integrating clinical, biochemical, and forensic findings in establishing the cause of death in suspected pesticide exposures. In addition, it underlines the continued relevance of classical toxicological methods as reliable and accessible tools for confirming phosphine exposure. • Phosphine poisoning may present with nonspecific autopsy findings. • Survival and intensive treatment may obscure morphological features. • Severe metabolic acidosis with preserved oxygenation suggests mitochondrial toxicity. • Toxicological analysis is essential for establishing the cause of death. • Classical qualitative methods remain valuable in forensic practice.
Brain induration is a classical autopsy finding historically linked to diabetes mellitus, though its underlying causes and specificity remain debated. Manual palpation to assess tissue stiffness is subjective. This study investigated whether biomechanical testing provides objective diagnostic value to assess tissue stiffness beyond time since death estimation. Brains from 44 adult autopsy cases were examined. Cylindrical samples from six different brain regions underwent oscillatory shear rheometry to determine storage, loss, and complex shear modulus. Cerebrospinal fluid and vitreous humor were analysed for glucose and lactate to calculate Traub sum values, and HbA1c was measured in venous blood when available. Autopsy reports were screened for medical history of diabetes mellitus and reported brain induration. Seven cases of the cohort had a known history of diabetes mellitus. Only one case of a known hyperosmolar hyperglycaemia prior to autopsy (Traub sum 636 mg/dl) was described as showing brain induration during autopsy. A second hyperosmolar hyperglycaemia case (Traub sum 458 mg/dl) also showed extreme stiffness but no reported induration. Both exhibited the lowest brain weights of the investigated cohort (1080 and 1120 g) and ranked among the top three stiffness values across all regions. Rheological stiffness significantly correlated with Traub sum values, but not with brain weight. Other causes of increased stiffness, such as traumatic brain injury with edema, produced high but regionally inconsistent values. Brain induration is associated with hyperosmolar hyperglycaemia rather than diabetes mellitus in general. Rheometry provided a sensitive, objective means to detect brain stiffening, whereas exceptionally stiff brains were not necessarily noted in autopsy reports based on routine manual palpation. • Brain stiffness seems to be associated with acute hyperosmolar hyperglycaemia rather than diabetes mellitus per se. • Diabetic cases without biochemical evidence of hyperosmolar hyperglycaemia showed no significant increase in brain stiffness. • Oscillatory shear rheometry provides an objective, quantitative measure of brain stiffness that outperforms manual palpation. • Rheologically measured brain stiffness correlated significantly with Traub sum values across all six examined brain regions. • Hyperosmolar hyperglycaemic cases showed consistently elevated stiffness across all brain regions.
The authentication of death from mechanical asphyxia (DMA) remains a significant challenge in forensic pathology because of the lack of specific biomarkers. The present study identified fumarate hydratase (FH), a key tricarboxylic acid (TCA) cycle enzyme, as a potential biomarker associated with DMA and investigated its regulatory mechanism in the context of acute severe hypoxia. Western blot analysis of 87 human myocardial samples revealed that FH protein expression was significantly downregulated in DMA cases than in controls (hemorrhagic shock, brain injury, and other causes). These findings were independently validated by immunohistochemistry (IHC) in a separate cohort of 118 human samples. The diagnostic performance of myocardial FH, evaluated by receiver operating characteristic curve analysis, yielded an area under the curve of 0.8561, with 84.38
Medical tubing misconnections represent a severe and often underreported hazard in clinical and home-care settings. While intravenous and enteral feeding misconnections are well-documented, accidental connections between oxygen delivery systems and urinary catheters are exceedingly rare. We present an unusual forensic case of a 65-year-old male with chronic obstructive pulmonary disease (COPD) and lower-body paralysis who accidentally connected his nasal cannula oxygen tubing to his suprapubic bladder catheter following a fall from his bed. The cause of death was determined to be acute respiratory failure secondary to barotrauma-induced tension pneumothorax and tension pneumoperitoneum, exacerbated by pre-existing pulmonary compromise. This case highlights the vital role of combining postmortem CT-scan with traditional autopsy to accurately diagnose complex barotrauma and gas distribution. Furthermore, it underscores the urgent need for standardized, incompatible connector designs (such as the ISO 80369 standards) to prevent fatal mechanical misconnections, especially in patients susceptible to hypoxia-induced cognitive impairment.
Hymenal examination plays an important role in the forensic examination of suspected child sexual abuse. However, interpretation of hymenal findings remains challenging because of anatomical variation and subtle genital injuries, creating the potential for misinterpretation in medico-legal assessments. This study aimed to characterize hymenal morphology, hymenal injuries, and related forensic findings among female child sexual abuse victims in Vietnam and to examine patterns associated with repeated abuse. A retrospective analysis was conducted using forensic examination records of female children under 16 years of age referred for suspected sexual abuse at a specialized medico-legal center. Sociodemographic characteristics, assault-related information, hymenal morphology, and genital and extra-genital injuries were extracted from standardized forensic reports. Cases with diagnostic uncertainty or complex forensic findings were reviewed through expert consultation, and final conclusions were established by consensus within the forensic assessment team. A total of 443 children were included, with a mean age of 13.3 ± 2.6 years. The median interval between the alleged assault and forensic examination was 19 days (IQR: 4–89 days). Repeated sexual abuse accounted for 68.4
Computed tomography has become an important tool in human identification, supporting comparative and reconstructive approaches. This study aimed to analyze the scientific literature on the use of computed tomography in human identification, focusing on publication trends, collaboration networks, and key themes to understand the field’s evolution. A bibliometric review was conducted following the Guideline for Reporting Bibliometric Reviews of the Biomedical Literature (BIBLIO). An electronic search was conducted in the Web of Science Core Collection. Records were ranked by citation count, and the most-cited articles were screened. Extracted data comprised authorship, country, publication year, journal, impact factor, study design, institution, keywords, citations, and research topic. Reviewer agreement was assessed with the Kappa coefficient (κ ≥ 0.81). Bibliometric analyses were performed in Power BI, and Spearman’s correlation was used to test associations between citation counts, journal impact factor, and year of publication. Scientific production increased from 2015 onwards. Most studies were observational, concentrating on age and sex estimation. A methodological shift was observed with the progressive introduction of artificial intelligence. Japan had the highest citation impact. Gifu University showed the highest citations per article, and Unicamp was the most productive institution. No significant association was identified between impact factor and citations. The results confirmed computed tomography as a strategic tool in forensic sciences, especially when combined with artificial intelligence. This study offers insights into the interface between radiology and forensics and paves the way for expanding the applicability of image-based human identification.
Instantaneous rigor, historically referred to as cadaveric spasm, remains a controversial concept in forensic pathology with divergent interpretations. Despite skepticism regarding its status as a distinct entity, apparent immediate postmortem fixation-particularly of the hands-continues to be reported. We describe a witnessed suicidal railway fatality in a 38-year-old female who exhibited unusual limb postures suggestive of instantaneous rigor. Detailed scene reconstruction and autopsy revealed heterogeneous limb positioning: some postures were attributable to biomechanical support, whereas others, particularly involving the hands, were not readily explained by environmental factors, object retention, or conventional postmortem changes. These findings may be better interpreted as reflecting terminal neuromuscular activity during a brief agonal phase, followed by stabilization of the resulting posture by early rigor mortis. A comparable suicidal hanging case demonstrated similar hand postures, providing additional observational support for this proposed interpretation. Overall, these observations are consistent with a hypothesis that apparent instantaneous fixation may represent a continuum of terminal neuromuscular phenomena rather than a distinct postmortem entity. Careful correlation of scene findings with autopsy features remains essential when interpreting such unusual postmortem postures. Although these observations are hypothesis-generating, they highlight the importance of distinguishing terminal agonal neuromuscular activity from postures traditionally attributed to cadaveric spasm during medico-legal interpretation.
Fatalities resulting from large felid attacks represent a rare subset of injuries in autopsy practice and are rarely documented in the medico-legal literature. Here, we present the case of a 67-year-old man who was fatally injured and extensively devoured by a captive African lion. An autopsy revealed multiple vital bite wounds to the head and neck with severance of the major neck vessels and the cervical spine. In addition, there was extensive postmortem damage, with defleshing injuries and bite marks to the lower extremities and multiple claw marks to the abdomen and back. The vitality of the wounds clearly decreased in the head-to-toe direction. Injury patterns inflicted by large felids on humans mirror their natural predatory behavior, with fatal bites typically targeting the cranio-cervical region. Unlike other large felids, lions may engage in postmortem consumption of human remains, an important feature for forensic considerations. Despite habituation to humans, captive large felids retain their predatory instincts, which may be triggered during feeding and play or by sudden movements. Given the rarity of such cases, this report provides additional insights into investigative strategies, mechanisms of attack, and injury morphology within this largely unexplored area of fatal large feline-to-human confrontation. In addition, this article consolidates the available literature on fatal and nonfatal large feline attacks on humans and highlights relevant medico-legal features for forensic professionals.
The illegal drug trade has changed dangerously since xylazine, a veterinary α2 adrenergic agonist, has become a common additive in illegally made fentanyl, creating the “tranq dope” mix. Together, they cause a synergistic central nervous system and respiratory depression that is more severe than that observed with opioid toxicity alone. This raises important questions about awareness, stigma, and clinicians’ responses. A scoping review was performed in accordance with PRISMA-ScR guidelines, utilizing a PCC-structured research question. Studies examining fentanyl and/or xylazine exposure with clinically or toxicologically significant data were searched in PubMed and ScienceDirect. 38 studies were included, most from North America, including case reports, retrospective studies, narrative reviews, animal studies, qualitative research, and toxicological analyses. Co-exposure to fentanyl and xylazine has been linked to severe necrotic cutaneous ulcers, unique postural phenomena like the forward-flexed “fentanyl fold,” acute muscle rigidity, including Wooden Chest Syndrome, and synergistic respiratory depression. Naloxone reverses the opioid component but does not counteract the sedative effects of xylazine, making overdose management more difficult and necessitating multimodal strategies like wound care, oxygenation support, and increased drug-checking services. Exposure to fentanyl-xylazine calls into question established models of opioid overdose and necessitates coordinated clinical and public health interventions. To combat this rapidly evolving threat, stigma must be reduced, harm reduction infrastructure expanded, and prospective research funded. Fentanyl–xylazine exposure is linked to more severe and prolonged overdoses. Naloxone reverses the opioid effect but not the sedation from xylazine. Atypical neuromotor and postural features may delay overdose recognition. Severe necrotic skin lesions are a frequent and concerning finding. This combination may change how opioid overdose presents clinically.
Accurate estimation of the postmortem interval (PMI) is essential in forensic medicine for reconstructing the timeline and circumstances of death. Artificial intelligence (AI) has emerged in recent years as a promising tool to enhance this estimation through the analysis of complex biological data. This study aims to conduct a systematic review of recent advances in AI applied to PMI estimation, complemented by a meta-analysis assessing the predictive performance of commonly used AI models such as neural networks, ensemble models, and random forest, using the area under the curve (AUC) as the primary metric. A literature search was conducted across PubMed, Scopus, and Google Scholar for the period 2015–2025, identifying 16 eligible studies. The analyzed models integrated microbiological, proteomic, imaging, and spectroscopic data, achieving over 90
Hair is a resilient forensic element capable of preserving morphological and biochemical information and may provide relevant evidence in cases of mechanical violence involving forcible traction or avulsion. This report describes the application of trichoscopy as a complementary tool in forensic medicine for the evaluation and documentation of traumatic hair-pulling injuries. A 66-year-old woman underwent forensic medical examination after reporting a single episode of hair traction injury resulting from interpersonal violence. Clinical assessment was performed, followed by trichoscopic examination of the affected scalp area to document hair shaft and follicular alterations. Trichoscopy revealed short terminal hairs of varying lengths, black dots, yellow dots, and the presence of vellus hairs. Petechial haemorrhages were not observed, probably due to the four-week interval between the traumatic event and forensic examination. The findings were compatible with post-traumatic alopecia after forcible traction. This case suggests that trichoscopy may represent a useful, painless, non-invasive, and reproducible complementary method for the objective documentation of traumatic scalp injuries, allowing digital image recording and highlighting its potential role as an auxiliary tool in forensic medicine.
Abstract Purpose Heart weight is a key parameter for assessing cardiac pathology, typically determined postmortem during autopsies. In forensic practice, the evaluation of cardiological records is crucial, particularly in sudden cardiac death cases, to identify pre-existing cardiac pathology. The comparison of ante- and postmortem cardiac pathology is challenging given the differing conditions of cardiological and forensic examinations. This study aimed to evaluate whether the echocardiographically combined calculation of left ventricular mass (LVM) and right ventricular mass (RVM) can nearly approximate the ‘true’ (postmortem) heart weight. Methods The hearts of 60 deceased were weighed after dissection, removal of blood and blood clots, rinsing, and drying. Antemortem echocardiographic measurements of the same individuals were used to calculate RVM and LVM. The sum of LVM and RVM was compared with postmortem heart weight, whereby epicardial fat and atrial tissue were included in the postmortem heart weight. Results Results showed relevant differences between estimated ventricular heart mass and postmortem heart mass (198.0–248.7 grams), with a strong Pearson correlation and a poor intraclass coefficient. The postmortem interval showed no relevant influence on the differences. Conclusion Possible explanations for these differences include postmortem changes, geometric alterations due to cardiac disease, measurement inaccuracies, and the exclusion of atrial tissue and epicardial fat. In conclusion, echocardiography provides a useful antemortem approximation of ventricular heart mass with implications for both clinical and forensic practices, but the estimated ventricular heart mass should be interpreted with caution and should not be used as a substitute for the total heart weight.
