Assessment of head gunshot wounds by means of post-mortem computed tomography in exhumed anonymous cadaver

Artur Wojciechowski,Paweł Skowronek,Marcin Fudalej

doi:10.1259/bjrcr.20150304

Abstract

Autopsy of corpses with advanced post-mortem changes is the most challenging aspect of medico-legal activities. In many cases, owing to soft tissue decomposition, making a final diagnosis as to the mechanism and cause of death is very difficult, and sometimes impossible (Carcione P, Argo G, Pincone D, Zgo S, Scopelliti L, Sortino C, Procaccianti P. Role of MCT vitropsy in evaluation of burned bodies and its comparison with traditional autopsy. Poster No.: C-1156, ECR 2014, Scientific exhibit). In such cases, the diagnostic process can be supported by post-mortem CT imaging. Post-mortem multislice CT imaging used in the field of forensic medicine is widely reported to be a good method for visualizing injuries and natural pathologies; however, only a limited number of forensic departments use this method in everyday practice. This method enables accurate assessment of bony injuries (fracture type, degree of bone displacement); has the ability to detect radiopaque foreign bodies, most frequently fragments of bullets; and in some cases enables soft tissue delineation (Hardy K. CT autopsy. Radiology Today 2008; 9: 20. Available from: http://www.radiologytoday.net/archive/rt01282008p20.shtml). In cadavers with advanced post-mortem changes, it is extremely difficult to retrieve the whole bullet or its parts. Owing to decomposition and reduced cohesion of the tissues, standard autopsy preparation techniques are impossible to perform. Post-mortem changes may also cause displacement of the bullet within the body in the long term, as well as at the time of transport following exhumation (Maiese A, Gitto L, De Matteis A, Panebianco V, Bolino G. Post mortem computed tomography: useful or unnecessary in gunshot wounds deaths? Two case reports. Leg Med (Tokyo) 2014; 16: 357–63). It is therefore important to perform post-mortem CT imaging directly after extraction of corpses in a similar position to how the dead body was exhumed. Interpretation of the images requires cooperation of forensic medicine specialists and radiologists to correlate radiological findings with autopsy.

Highlights

The common feature of all gunshot wounds is the presence of damage to the soft tissues at the site of entry along with the presence of a rim of bruising at the vicinity of the entry wound, which is called contusion haematoma
Wounds inflicted by close range shots are characterized by the presence of gunpowder tattoo——particles of gunpowder embedded in the skin and skin burn due to hot exhaust gases from the barrel
Even potentially fixative changes such as mummification or fat-wax transformation can obscure the features of an entry wound

Summary

Introduction

The common feature of all gunshot wounds is the presence of damage to the soft tissues at the site of entry along with the presence of a rim of bruising at the vicinity of the entry wound, which is called contusion haematoma. Wounds inflicted by close range shots are characterized by the presence of gunpowder tattoo——particles of gunpowder embedded in the skin and skin burn due to hot exhaust gases from the barrel. These changes are not clearly seen in the soft tissues undergoing post-mortem decomposition and change. The external cover makes them less prone to shape change and distortion during the initial contact with soft tissues. Shotgun shells contain multiple small beads or lead slugs that exit the barrel at a lower speed; the large number of small projectiles can cause extensive damage to the body, with close range gunshots.[1]

Objectives

Conclusion