1.8. PMCT findings in hanging

Abstract

Objectives Compare findings seen at autopsy and PMCT in cases of uncomplicated suicidal hangings. Materials and methods Retrospective search of forensic and PACS database for adult hanging deaths returned 47 cases that underwent whole body PMCT, where autopsy was blinded to imaging. Autopsy findings collected from autopsy reports by a board certified forensic pathologist. Whole body PMCT performed using a 16 slice big bore CT scanner. Images interpreted by a board certified radiologist with forensic imaging experience, blinded to autopsy results. Data reconciliation and analysis performed by consensus. Results Subcutaneous gas collections in the head and/or neck out of proportion to decomposition in 12 cases (25.5%), seen only at PMCT. Neck muscle hemorrhage found in 5 cases, 3 (6.4%) detected at autopsy and 2 (4.3%) by PMCT. 3 cases (6.4%) of hyoid injury identified, seen only by PMCT. 2 cases (4.3%) of thyroid injury, seen only at autopsy. 3 (6.4%) head/neck fractures identified only by PMCT. Various findings encountered in the brain, chest and abdomen by autopsy, PMCT or both, which were unrelated to the cause of death. No unexplained serious trauma detected by either modality. Conclusion Subcutaneous gas in the head and neck was common and seen only at CT, possibly related to the mechanism of death or altered gas distribution during decomposition in hangings. Neck muscle hemorrhage, thyroid injury or hyoid injury occurred in the minority of cases. A small percentage of potentially relevant head/neck fractures were identified at CT that were not seen at autopsy. Findings in the brain, chest and abdomen were generally noncontributory.