"Blind spots" in forensic autopsy: improved detection of retrobulbar hemorrhage and orbital lesions by postmortem computed tomography (PMCT)

P M Flach; T C Egli; S A Bolliger; N Berger; G Ampanozi; M J Thali; W Schweitzer

doi:10.1016/j.legalmed.2014.06.003

"Blind spots" in forensic autopsy: improved detection of retrobulbar hemorrhage and orbital lesions by postmortem computed tomography (PMCT)

Leg Med (Tokyo). 2014 Sep;16(5):274-82. doi: 10.1016/j.legalmed.2014.06.003. Epub 2014 Jun 26.

Authors

P M Flach¹, T C Egli², S A Bolliger³, N Berger⁴, G Ampanozi³, M J Thali³, W Schweitzer³

Affiliations

¹ Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland. Electronic address: Patricia.flach@irm.uzh.ch.
² Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland.
³ Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland.
⁴ Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland; Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.

PMID: 25017308
DOI: 10.1016/j.legalmed.2014.06.003

Abstract

Objectives: The purpose of this study was to correlate the occurrence of retrobulbar hemorrhage (RBH) with mechanism of injury, external signs and autopsy findings to postmortem computed tomography (PMCT).

Methods: Six-teen subjects presented with RBH and underwent PMCT, external inspection and conventional autopsy. External inspection was evaluated for findings of the bulbs, black eye, raccoon eyes and Battle's sign. Fractures of the viscerocranium, orbital lesions and RBH were evaluated by PMCT. Autopsy and PMCT was evaluated for orbital roof and basilar skull fracture.

Results: The leading manner of death was accident with central regulatory failure in cases of RBH (31.25%). Imaging showed a high sensitivity in detection of orbital roof and basilar skull fractures (100%), but was less specific compared to autopsy. Volume of RBH (0.1-2.4ml) correlated positively to the presence of Battle's sign (p<0.06) and the postmortem interval. Ecchymosis on external inspection correlated with RBH. There was a statistical significant correlation between bulbar lesion and RBH. Orbital roof fracture count weakly correlated with the total PMCT derived RBH volume. Maxillary hemosinus correlated to maxillary fractures, but not to RBH.

Conclusions: RBH are a specific finding in forensically relevant head trauma. PMCT is an excellent tool in detecting and quantifying morphological trauma findings particularly in the viscerocranium, one of the most relevant "blind spots" of classic autopsy. PMCT was superior in detecting osseous lesions, scrutinizing autopsy as the gold standard.

Keywords: Eye; Forensic; Forensic radiology; PMCT; Postmortem imaging; Retrobulbar bleeding; Virtopsy; Virtual autopsy.

MeSH terms

Autopsy*
Eye Injuries / diagnostic imaging*
Forensic Pathology / methods*
Humans
Image Interpretation, Computer-Assisted
Retrobulbar Hemorrhage / diagnostic imaging*
Retrobulbar Hemorrhage / etiology
Sensitivity and Specificity
Tomography, X-Ray Computed*