Background Systemic air embolism is a rare but potentially fatal complication of invasive medical procedures, including endoscopic retrograde cholangiopancreatography (ERCP). Accurate post-mortem diagnosis is challenging, as conventional autopsy may fail to reveal the full extent and distribution of intravascular gas. Case presentation We report a 65-year-old male with obstructive jaundice who underwent ERCP for stenting and tissue sampling of a suspected distal bile duct carcinoma. During the procedure, a sphincterotomy and guidewire-induced false tract allowed insufflated air to escape into the retroperitoneum and vasculature, resulting in cardiorespiratory collapse. Post-mortem computed tomography (PMCT) demonstrated abundant gas throughout the cardiac ventricles, retroperitoneum, and mesocolon. Volumetric rendering quantified the abnormal gas burden, providing objective radiological evidence supporting the diagnosis of fatal systemic air embolism. Autopsy corroborated the sphincterotomy defect, retroperitoneal air, and underlying cholangiocarcinoma. Discussion PMCT enables visualisation of abnormal gas distributions before organ manipulation, distinguishing pathological gas from post-mortem artefact. Volumetric rendering quantified the abnormal gas burden, providing objective radiological evidence supporting the diagnosis of fatal systemic air embolism. Conclusion This case highlights the pivotal role of PMCT with volumetric rendering in procedure-related deaths. By providing pre-dissection insight into gas distribution and volume, PMCT enhances the forensic evaluation of iatrogenic vascular air embolism, representing a critical step in establishing the cause of death.
Accurate estimation of the postmortem interval (PMI) is fundamental in forensic investigations. A routine approach is the biochemical analysis of vitreous humour. However, challenges include invasive sample collection and the potential for multiple sources of error in the analytical workflow, which may affect the precision of PMI estimation. Magnetic resonance imaging (MRI) relaxation parameters may provide non-invasive indicators of cumulative postmortem alterations within the vitreous humour. This study therefore aimed to evaluate associations between PMI and MRI relaxometry in the vitreous humour.Postmortem head MRI at 3T was performed in 17 forensic cases (age at death = 56.1 ± 14.8 years; 4 females, 13 males; PMI = 40.9 ± 22.8 hours [12 h, 82 h]). Forehead temperature was continuously measured during scanning. The vitreous body was manually segmented to enable quantification of the relaxation parameters T1, T2, and T2*. Linear regression analysis was conducted to assess association with PMI. Forehead temperature was included as a statistical covariate.The model including T2* showed the strongest association with PMI (R2 = 0.56, p < 0.01), with both temperature (p < 0.01) and T2* (p = 0.02) independently contributing to the prediction. The association between T2* and PMI was negative. Models including T1 or T2 demonstrated weaker associations and no significant independent effects of the relaxation parameters or temperature.The observed associations in this exploratory study suggest that vitreous T2* may be a potential marker for PMI estimation, although larger datasets are required for model calibration and validation.
Objectives To develop and validate new regression equations to estimate the age of children and adolescents in a Yemeni population based on mandibular measurements. Materials & Methods This analytical cross-sectional study was conducted in two phases: the first phase included 338 individuals (141 females and 197 males), whose age ranged between 1 and 20 years. All mandible images were obtained using a 128-slice multidetector CT scanner. Seven mandibular dimensions were measured using the RadiAnt DICOM Viewer program. Linear regression was performed to develop age estimation equations. The second phase included a separate sample composed of 60 CT scans to validate and test the accuracy of the developed equations. Results The study demonstrated significant positive correlations between mandibular measurements and chronological age ranged from 0.788 for the chin height to 0.959 for the right ramus height (all p < 0.01). The single-dimension regression equations demonstrated high predictive power with determination coefficient ranging from 0.628 to 0.919. The multiple regression equations demonstrated the best overall performance and yielded the highest determination coefficients (R2=0.946 for males and 0.898 for females). Validation results indicated that the multiple regression equation yielded the lowest mean absolute error of 0.975 years (males) and 1.167 years (females), with the highest overall accuracy of 87.75% and 83.27%, respectively. Conclusions CT-based mandibular measurements are reliable indicators for estimating children and adolescents age. These findings offer a powerful tool for forensic, clinical, and anthropological applications within the Yemeni population. Further external validation is encouraged to enhance model applicability in diverse populations.
Decomposition changes the physical state and, thus, the imaging appearance of the body. Hallmarks of early decomposition are gas in the right heart and portal veins. When gas distribution is atypical, pathological conditions should be considered. Blood products can remain evident on PMCT even in moderate to advanced states of decomposition. As decomposition progresses, gas and fluid collections occur in all tissues and cavities, limiting diagnostic power. However, PMCT remains highly sensitive for the detection of skeletal injuries. Experienced interpreters are required to accurately differentiate between decomposition changes and pathology. The Guidelines Working Group of the International Society of Forensic Imaging endorses the application of non-contrasted PMCT for decomposed remains.
