title: Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation.
abstract: Cases of subtle fatal neck compression are often complicated by the lack of specificity of the post-mortem signs of asphyxia and by the lack of clear signs of neck compression. Herein we present a forensic case of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest and who died after two days in a vegetative state. The deposition of the roommate of the deceased, who claimed responsibility for the killing of the victim by neck compression, was considered unreliable by the prosecutor. Autopsy, toxicological analyses, and multi-slice computed tomography (MSCT), micro computed tomography (micro-CT) and histology of the larynx complex were performed. Particularly, micro-CT analysis of the thyroid cartilage revealed the bilateral presence of ossified triticeous cartilages and the complete fragmentation of the right superior horn of the thyroid, but it additionally demonstrated a fracture on the contralateral superior horns, which was not clearly diagnosable at MSCT. On the basis of the evidence of intracartilaginous laryngeal hemorrhages and bilateral microfracture at the base of the superior horns of the larynx, the death was classified as a case of asphyxia due to manual strangulation. Micro-CT was confirmed as a useful tool in cases of subtle fatal neck compression, for the detection of minute laryngeal cartilage fractures, especially in complex cases with equivocal findings on MSCT.
authors.affiliation: Unit of Forensic Medicine, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134 Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fais
authors.affiliation: University of Vienna, Department of Radiology and Nuclear Medicine, Währinger Gürtel Strasse 18-20, 1090 Vienna, Austria.
authors.forename: Chiara
authors.initials: C
authors.lastname: Giraudo
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121 Padova, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Viero
authors.affiliation: Institute of Radiology, University-Hospital of Padova, Via Giustiniani 3, 35121 Padova, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.affiliation: Unit of Forensic Medicine, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134 Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Bortolotti
authors.affiliation: Unit of Forensic Medicine, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134 Verona, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Tagliaro
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121 Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Montisci
authors.affiliation: Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121 Padova, Italy. Electronic address: cecchetto.gio@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cecchetto
mesh_terms: D001237:Asphyxia / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001344:Autopsy; D049429:Forensic Pathology / Q000379:methods; D050724:Fractures, Cartilage / Q000000981:diagnostic imaging*; D006801:Humans; D006928:Hyoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries; D007830:Larynx / Q000000981:diagnostic imaging* / Q000293:injuries; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D055114:X-Ray Microtomography / Q000379:methods
keywords: Asphyxia; Larynx fractures; MSCT; Micro-CT; Strangulation