Postmortem ventilation in cases of penetrating gunshot and stab wounds to the chest.
We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT). The study included 6 subjects (1 female, 5 male; age 32-67years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results. In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium. The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required.
Institute of Forensic Medicine, Center of Forensic Imaging and Virtopsy, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland; Institute of Forensic Medicine, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Electronic address: Germerott.Tanja@mh-hannover.de.
Tanja
T
Germerott
Ulrich S
US
Preiss
Steffen G
SG
Ross
Michael J
MJ
Thali
Patricia M
PM
Flach
D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D005260:Female; D049429:Forensic Pathology / Q000295:instrumentation / Q000379:methods*; D006491:Hemothorax / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic / Q000379:methods; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D012122:Ventilators, Mechanical; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000473:pathology*; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000473:pathology*
Forensic imaging; PMCT; Postmortem computed tomography; Postmortem imaging; Postmortem lung; Postmortem ventilation