Reviewing postmortem photographs is routine in forensic pathology. Although standard photographic techniques are used, sorting postmortem photographs can be overly time-consuming, especially when reviewing large quantities of photographs. Artificial intelligence may assist in identifying body parts/locations but is challenged in determining spatial relationships such as sidedness, angle, and distance/depth. Metadata stored in modern digital cameras provides physical data that would assist in determining this information, which can be critical in the legal setting. This proof-of-concept study used photograph metadata and artificial intelligence to develop a tool to sort postmortem photographs using living volunteer subjects. This "tool" automatically sorts through general, close-up images (hands, eyes, face, and hands) and mock injury (with a scale) photographs. The study compared using photograph metadata and artificial intelligence in different proportions (hybrid photograph metadata and artificial intelligence vs. artificial intelligence alone). Results demonstrated that using both metadata and artificial intelligence for different tasks was more accurate and efficient than using artificial intelligence alone.
Artificial Intelligence (AI) has rapidly become a widespread technology, with many forms being freely accessible to anyone with internet access. Recently there has been an influx of digital applications, or apps, that claim to utilize the power of generative artificial intelligence (GAI) to identify everything from plant species to works of art based on a single photograph. Because these apps are emerging quickly and without oversight, their accuracy is largely unknown, and there are rarely disclaimers that indicate the probability of correctness for the app overall, or for a single result. We test a GAI-driven application that was originallymeant to assist medical students in their studies of human bone, but currently being used by some law enforcement to identify osseous remains as human or nonhuman. Thus, the goal of this project was to assess the accuracy of this application. Several test sets of known human and nonhuman skeletal elements were scanned into the application utilizing the digital devices integrated camera, as the application was intended for use. Three test sets of human and nonhuman skeletal remains were submitted to the application via image upload for analysis. The first test set consisted of 50 human and nonhuman bones typically submitted to the medical examiner’s office for analysis. The second test set consisted of 5 nonhuman bones that were individually photographed and submitted in random order to the application five times, for a total of 25 images, to the application in a random order to test the application’s repeatability. The final test set utilized 16 images of a nonhuman tibiotarsus from an Palaeognathae since it is similar in size to a human femur. Overall, this application performed poorly in a controlled laboratory setting on each of the three test sets. In the first test set, it correctly classified the name of the bone (eg, skull, humerus, “hip bone”) seven out of 50 times (14%). It correctly identified nonhuman bones (by specifically stating that the bone was nonhuman) in three out of the 50 images (6%). It misclassified long bones (eg, identifying a humerus as a femur) 23 out of 50 images (46%). The second test of the app provided an overall accuracy of correct bone classification in 25 trials of 32%. In the third test set, fourteen of the sixteen images (87.5%) uploaded were misclassified as a presumably human “Femur,” while the other two were unable to be classified. The authors advise caution when using applications like this one to assess material with evidentiary potential.
Firearms are a leading cause of violent injury and death. Most crime-related shootings and fatalities within the United States involve low-velocity, medium-caliber or large-caliber firearms, such as .380 Automatic Colt Pistol (ACP), 9 mm, 0.40 Smith & Wesson, or 0.45 ACP handguns, or high-velocity firearms, such as Assault Rifle-15 self-loading rifles. Low-velocity, small-caliber rounds, such as the ubiquitous 0.22 long-rifle cartridge, are occasionally encountered in crime-related shootings, but are less common than incidents involving center-fired cartridges. A lesser-known small-caliber cartridge is the 0.17 Hornady Magnum Rimfire (HMR). Like the 0.22 cartridge, the 0.17 cartridge is rim-fired, being contained in a casing that is of similar diameter as a normal 0.22; however, the neck of the casing is tapered down to contain the 0.17 diameter projectile. In contrast to the 0.22, the 0.17 HMR is considered a high-velocity round and is touted as an excellent choice for hunting small game and eliminating varmints. There is limited literature documenting deaths and wounds from these high-velocity, rim-fired, small-caliber bullets. Herein, we describe 2 homicide cases where 0.17 HMR caliber bullets were involved in lethal outcomes.
Mineral (paraffin) oil is a chemically inert substance that has rarely been reported as an injectable agent for cosmetic purposes. We describe the pathologic findings of a fatal case of systemic mineral oil embolism in a young adult woman following a subcutaneous buttock injection. The injected oil rapidly entered the circulation, resulting in systemic embolization and hypoxic-ischemic brain injury.
Coronary artery anomalies (CAAs) are rare but critical contributors to sudden cardiac death (SCD) in young individuals. This study reviews 12 cases from the statewide Utah medical examiner system over 33 years, including 4 infants, 2 children aged 3 years, and 6 adolescents (12 to 19 y). Autopsies revealed various CAAs: 3 cases with arteries originating from the pulmonary circulation, 6 cases with anomalous origins between the aorta and pulmonary trunk, 2 cases with ostial displacement and stenosis, and 1 case with abnormal anterior coronary formation. Of the 11 cases where histology was performed, 8 of them showed acute or chronic myocardial ischemia. Notably, 5 of 6 adolescents collapsed during physical exertion, highlighting the role of stress in triggering fatal events. This series underscores the importance of recognizing CAAs as a significant cause of SCD in young individuals, often in the absence of prior cardiac symptoms. Accurate identification of these anomalies at autopsy is crucial for understanding and preventing future tragic outcomes. With thorough exams and descriptive reports by the forensic pathologists, this information can enhance awareness and aid clinicians in early detection and intervention in living children, potentially reducing the incidence of unexplained sudden deaths.
Electrical injuries are associated with multiple factors, including the current itself, the amount of current flowing through the body during electrocution, the duration of the flow, and the duration of exposure. The instances of bone fracture following electrocution are limited. This article such a rare incident, where an elderly woman suffered an electrical shock at her residence while switching off the refrigerator. The woman complained of intense pain around her left shoulder, with restricted movement of the shoulder joint, without any history of a fall or other trauma. Detailed physical and radiologic examinations revealed an electrical entry wound on the left palm and a proximal humerus fracture. The patient underwent surgery and was discharged without complications. This case highlights bone fracture as a rare manifestation of electrocution resulting from violent muscular contractions as electricity passes through the body, even in cases of domestic low-voltage electrical shock. The authors recommend a meticulous general physical examination and radiologic imaging with X-rays and computed tomography (CT) scans, which may assist forensic assessment of how such injuries may occur.
Artificial intelligence (AI) technologies have begun to be used more frequently in forensic sciences, just as in every other field of medicine, and have become part of research topics. This study aims to conduct a comprehensive bibliometric analysis to systematically examine publication dynamics, collaboration networks, citation patterns, and thematic trends of AI in forensic sciences. A comprehensive literature search was conducted using the keywords “forensic medicine,” “forensic sciences,” “forensic pathology,” autopsy, “artificial intelligence,” “deep learning,” and “machine learning” and analyzed using R Bibliometrix and VOSviewer software. The analysis identified 3434 authors, 8372 keywords, and 6276 references across 730 articles. A publication growth rate of 24.16% and international collaboration rate of 28.77% were observed. The United States emerged as the most productive country. The leading institutions were University of California and Shanxi Medical University. Research trends concentrated on diagnosis, bone age estimation, and forensic odontology. Publications appeared predominantly in high-impact journals including Forensic Science International and Nature Communications. AI and machine learning research in forensic sciences has experienced rapid growth. Although these technologies offer substantial potential to enhance accuracy, efficiency, and standardization in forensic investigations, critical challenges such as model interpretability and ethical considerations require further attention for future implementation.
Tramadol is a centrally acting analgesic that is widely prescribed for the management of postoperative pain, and it is often considered to have low abuse potential. Fatal pediatric mono-intoxication is an exceptionally rare occurrence. The following report details the case of a 4-year-old child with no significant medical history, who was found dead in his bed 24 hours after undergoing circumcision. According to the family, the mother administered a single dose of 90 drops of Tramal (~400 mg) in accordance with the prescribed postoperative medication plan. A forensic autopsy was conducted, which revealed a eutrophic child with no traumatic injuries and pulmonary edema as the only significant finding, confirmed histologically. Postmortem toxicological analysis demonstrated a plasma tramadol concentration of 2500 ng/mL, which exceeds the therapeutic range (100-300 ng/mL) and is above the concentration often cited as fatal (>2000 ng/mL) in toxicological references. A thorough examination of the pharmaceutical container confirmed the presence of an excessive dose of the drug. The cause of death was attributed to acute tramadol intoxication, most likely due to respiratory depression. This case underscores the critical role of forensic toxicology when autopsy findings are nonspecific and highlights significant medicolegal concerns regarding prescription practices and parental education.
Meconium aspiration syndrome (MAS) is a disease of near-term, term, or post-term newborns linked to increased infant morbidity. It results from inhalation of meconium-stained amniotic fluid (MSAF). MSAF occurs in 4% to 22% of pregnancies; 3% to 12% of those affected by MSAF develop MAS, which has a fatality rate of <1%. The presence of meconium in the amniotic fluid often indicates fetal distress. We present a case of severe MAS overlooked at birth, highlighting the importance of including MAS in the differential of sudden natural death in infancy, particularly with MSAF, even if APGAR scores are reassuring. This case involves a 1-day-old male, born at 42 weeks after an uncomplicated pregnancy and midwife-led water birth with MSAF. APGAR scores were reported as 8/9 with no initial respiratory issues. He had poor latch and lethargy, became apneic during feeding at 16 hours, and died despite attempted resuscitation. The postmortem revealed meconium staining, right ventricular hypertrophy, diffuse alveolar damage, meconium-laden macrophages, airway obstruction, and histologic evidence of persistent pulmonary hypertension of the newborn (PPHN). MAS is a recognized complication of term deliveries. Postnatal bathing can obscure meconium signs, complicating autopsy confirmation. Out-of-hospital births hinder diagnosis and management, making histology essential. The absence of visible meconium or high reported APGAR scores should not exclude the diagnosis of MAS. This case highlights the forensic pathologist's role in infant death investigations and the need for heightened clinical vigilance in the postnatal period.
High-voltage electrical arc injuries are a severe occupational hazard, but fatal cases involving a “near-contact” or “contactless” mechanism are sparsely documented and prone to misinterpretation. We present a case that integrates forensic engineering analysis with pathognomonic autopsy findings to provide a clear diagnostic reference. A 51-year-old male painter was found in cardiorespiratory arrest while using an aluminum pole to paint a commercial facade. A forensic engineering examination revealed the pole was within 170 cm of a high-voltage power line. The autopsy revealed classic electrical entry and exit wounds alongside a distinct thermal burn on the right flank. The integration of scene measurements and specific autopsy findings suggests death by electrocution via a near-contact electrical arc. The thermal burn illustrates a secondary injury mechanism from the arc flash. This case provides a clear methodological and pathological framework for diagnosing these complex occupational fatalities, where the absence of evidence of direct contact or the presence of associated thermal burns can be misleading.
Air weapons use compressed gas to fire projectiles without igniting gunpowder. Although commonly perceived as recreational devices, modern air rifles can reach muzzle velocities exceeding 1000 feet per second and are capable of inflicting fatal injuries. This report describes 2 unusual fatalities from air weapon chest wounds: a 15-year-old male who sustained a self-inflicted injury while handling an air rifle, and a 61-year-old male shot by another individual. Both victims died shortly after sustaining the wound despite medical intervention. Autopsies revealed penetrating chest injuries with retained wasp-waisted pellets within the left lung, and the manner of death was certified as suicide and homicide, respectively. A literature review identified only a few comparable fatalities, including 2 suicides and 3 homicides involving chest injuries. Despite their small caliber and widespread availability, air weapons can produce sufficient kinetic energy to penetrate skin, bone, and vital organs. These cases emphasize the lethal potential of air rifles and the diagnostic challenges they can present during forensic investigation. While commonly regarded as low-risk devices, these weapons demonstrate considerable lethality and should be subject to stronger regulatory oversight.
This study evaluates the epidemiological, clinical, and autopsy findings of 6 rabies-related deaths occurring in the Şanlıurfa province of southeast Türkiye between 2012 and 2023. The primary objective was to identify region-specific risk factors and preventable causes through a retrospective, descriptive analysis. The study group comprised 5 males and 1 female, with a mean age of 18.4 years. All cases involved animal contact, categorized as either scratches (n=3) or bites (n=3). A critical finding regarding postexposure prophylaxis was that only one case received both the vaccine and immunoglobulin, while the remaining five received the vaccine alone. Clinically, hypersalivation and aggressiveness were the most frequently observed symptoms, each occurring in 50% of the cases. The mean survival time following the onset of symptoms was 24.3 days. Among the cases undergoing autopsy and histopathologic evaluation, encephalitic changes and, in selected cases, Negri bodies were identified. Although rabies is a preventable public health threat, these findings suggest that fatalities in the region are closely associated with insufficient prophylaxis and unequal access to health care services. To mitigate future risks, it is of vital importance to strengthen preventative health care in high-risk areas, ensure the control of stray animal populations, and provide comprehensive training for health care personnel on current prophylaxis guidelines.
Intussusception is the telescoping of one bowel segment into another, causing obstruction and ischemia. It is uncommon in adults and is most often associated with an underlying neoplasm. Colonic involvement is less frequent, and arteriovenous malformations (AVMs) represent an unusual etiology, with no previously reported fatal rectosigmoid cases to our knowledge. We describe the case of a 41-year-old man with a medical history of tuberculosis and gastrointestinal disease who suddenly developed severe abdominal pain at home. His condition rapidly deteriorated, and he was transported to the emergency department, where he arrived in cardiac arrest. External examination revealed no signs of trauma. Autopsy showed bilateral pleural effusion and markedly emphysematous lungs. Abdominal examination revealed peritoneal effusion, diffuse bowel wall thickening, and hemorrhagic intraluminal content. A colo-recto-sigmoid intussusception causing near-complete obstruction was identified, with a firm intraluminal mass acting as the lead point. Histopathologic analysis demonstrated a vascular lesion composed of arteries, veins, and capillaries associated with neural hyperplasia, favoring a vascular malformation with AVM-like features. No malignancy was found. This case describes a fatal rectosigmoid intussusception associated with a colonic vascular lesion showing AVM-like features and underscores the importance of considering vascular lesions as potential lead points in adult intussusception.
This retrospective forensic autopsy study investigated the association between body mass index (BMI) and suicide by hanging in Türkiye. Autopsy records from 15,014 cases examined between 2019 and 2021 were reviewed, and 994 confirmed hanging deaths with reliable anthropometric measurements were included. BMI values were calculated using autopsy-derived height and weight measurements and classified according to World Health Organization criteria. The distribution of BMI categories among hanging cases was compared with age- and sex-matched national population data. The majority of cases were male (79%), with a mean age of 41.6±15.8 years. Normal and overweight BMI categories predominated, whereas obesity was significantly underrepresented compared with the general population. Statistical analyses demonstrated a progressive decrease in the likelihood of suicide by hanging with increasing BMI in both sexes. In men, hanging was significantly more frequent in low and normal BMI categories, while obesity was associated with a reduced risk. In women, a significant association was observed only in the normal BMI group. These findings indicate that BMI may influence suicide method selection and should be considered in forensic and public health evaluations of suicidal behavior.
With the advent of percutaneous coronary reperfusion, the incidence of cardiac rupture in the setting of myocardial infarction has decreased substantially. Yet cardiac rupture remains a widely feared complication due to its rapid onset and limited therapeutic options. The early identification of individuals most at risk for rupture, as well as modifiable risk factors that contribute to delays in therapy, is crucial for improving outcomes associated with this disease. A retrospective review of autopsies performed between 2010 and 2024 at the Cuyahoga Office of Chief Medical Examiner revealed 288 cases of myocardial infarction, of which 63 (22%) were complicated by cardiac rupture. Decedents with cardiac rupture were more likely to be White and older than decedents without rupture. When compared with age, race, and sex-matched controls, decedents with rupture were less likely to demonstrate cardiomegaly and myocardial fibrosis at autopsy and to have a documented history of diabetes mellitus. There was no difference in the receipt of cardiopulmonary resuscitation between the groups. The study group demonstrated a much higher rate of cardiac rupture and a longer duration of preceding symptoms than has been previously reported in clinical studies.
It is accepted that congenital and acquired heart disease increase the risk of sudden cardiac death. To our knowledge, there are no published studies on the types of heart disease in cases of arrest-related deaths. The goal of this study, therefore, was to consider a large body of autopsy reports of non-firearm arrest-related deaths to analyze the presence of heart disease with regard to numerous decedent variables and toxicology findings. We analyzed 1650 autopsy reports covering the years 2005-2024 and classified cardiac findings into larger subgroups. Most of the cases (95%) were men, and the mean age was 38 years, with a range of 14 to 95. The racial classification was black (40.2%), Hispanic (17.8%), and non-Hispanic white (38.8%). There was some type of cardiac abnormality described in 61% of the group. The most common were cardiomegaly (35.8%), cardiac hypertrophy (23.6%), moderate to severe coronary disease (15.0%), cardiomyopathy (14.5%), and hypertensive cardiac disease (12.2%). At 61%, the rate of any heart disease is significantly higher than the expected rate of 1% to 2% for this age group in living patients. The rates of specific heart diseases were also significantly higher. For example, the general population rate of dilated cardiomyopathy is estimated to be 0.4% and contributes to 0.2% of deaths, whereas in this group of autopsy-diagnosed young men, the prevalence was 4%. Our findings show a high rate of subclinical heart disease in people experiencing non-firearm arrest-related deaths. It is possible that these findings show an increased clinical risk in this population. The incidence of heart disease is increasing with time for this population.
N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by ventricular myocardial cells and released in response to ventricular wall stress conditions such as congestive heart failure (CHF). We previously reported the potential diagnostic efficacy of postmortem urine NT-proBNP concentrations for acute myocardial infarction, CHF, heat stroke, and sepsis. As urine is often unavailable in autopsy cases, alternative diagnostic methods are required. In this study, we conducted NT-proBNP immunostaining of the kidney, evaluated NT-proBNP positivity in the renal tubule in a series of forensic autopsy cases (n = 30), and compared the results to the urinary levels of NT-proBNP and urine Hounsfield unit (HU) values in postmortem computed tomography conducted before the autopsy. The results showed significantly higher urinary NT-proBNP levels in the CHF, sepsis, and heat stroke groups than in the control group. NT-proBNP positivity was also significantly higher in these groups. Moreover, a correlation between urinary NT-proBNP concentration and immunostaining results was observed. These results suggest that NT-proBNP immunostaining of the kidney could be considered as an alternative to NT-proBNP measurement in urine, which may, in turn, improve postmortem diagnosis. However, the association with postmortem urine HU values should be evaluated in further large-scale studies.
