Postmortem Computed Tomography: A Supplant Technique to Autopsy for Firearm Injuries in the Head

Abstract

Background: Autopsy is more time-consuming if the bullet/bullets are lodged at the difficult-to-access sites of the head, especially maxillofacial regions. The procedure of suturing the deceased becomes even more difficult after the retrieval of bullets post-dissection of facial tissues. The altered aesthetics psychologically and emotionally disturb the already bereaved next of kin. The authors explored the utility of PMCT and propose a methodology of targeted dissection/minimally invasive approach to retrieve the bullet. The authors discussed the feasibility to conclude the cause of death in cases of single/multiple firearm injuries to the head using PMCT alone. Methods: The authors evaluated three cases of firearm deaths at a distance lesser than close range to the head. The deceased was subjected to PMCT scanning using a 16-slice Multi-Slice CT spiral scanner and findings were analyzed using the Vitrea software v.6.9.1 with the slice thickness ranging from 0.5mm to 5mm. A routine conventional autopsy was conducted post-scanning. Two of the three cases were suicide and succumbed to a single firearm injury while the third case was a homicide due to multiple firearm injuries. Conclusion: PMCT alone can be utilized and relied upon in deaths due to a single shot to the head and suggests a combined methodology of PMCT evaluation and minimally invasive approach in cases of multiple firearm injuries for better correlation of wound track. Lastly, PMCT helped in a targeted approach to reach the in situ bullets more precisely than any other radiological technique which upholds the humanitarian forensic aspect.