title: Postmortem computed tomography and magnetic resonance imaging facilitates forensic autopsy in a fatal case of poisoning with formic acid, diphenhydramine, and ethanol.
abstract: A case of fatal poisoning by ingesting formic acid, diphenhydramine, and ethanol by a 25-year-old woman who committed suicide is presented. Prior to autopsy, postmortem computed tomography and postmortem magnetic resonance tomography were performed and revealed severe damage to the stomach, the left thoracic wall, and parts of the liver. Imaging detected acid-induced fluid-fluid level within the thoracic cavity (fat-equivalent fluid and necrotic pleural effusion). This case report illustrates that postmortem cross-sectional imaging may facilitate dissection of severely damaged or complex regions, and may provide additional information compared to autopsy and toxicological examinations alone.
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland. florian.berger@irm.uzh.ch.
authors.forename: Florian
authors.initials: F
authors.lastname: Berger
authors.affiliation: Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Steuer
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University of Basel, Hebelstrasse 10, 4056, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rentsch
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Dominic
authors.initials: D
authors.lastname: Gascho
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Stamou
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schärli
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
authors.affiliation: Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Krämer
authors.affiliation: Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, Virtopsy, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flach
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000000981:diagnostic imaging* / Q000473:pathology; D002492:Central Nervous System Depressants / Q000506:poisoning*; D004155:Diphenhydramine / Q000506:poisoning*; D000431:Ethanol / Q000506:poisoning*; D005260:Female; D049429:Forensic Pathology; D005561:Formates / Q000506:poisoning*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000506:poisoning*; D008279:Magnetic Resonance Imaging; D061330:Multidetector Computed Tomography; D013405:Suicide
chemical_list: D002492:Central Nervous System Depressants; D005561:Formates; D006993:Hypnotics and Sedatives; C030544:formic acid; D000431:Ethanol; D004155:Diphenhydramine
keywords: Diphenhydramine; Ethanol; Fatal combined intoxication; Formic acid; Postmortem computed tomography; Postmortem magnetic resonance tomography; Virtopsy