Anterior approach for a stab wound with penetrating rebar injury causing incomplete cauda equina syndrome in lumbosacral spine lesion: a case report and literature review.

PURPOSE: To report a unique case of incomplete CES following a rebar penetrating injury in perineal region with retro-pulsed fragment, which was treated with anterior approach and discuss suitable surgical approach. METHODS: Incomplete cauda equina syndrome caused by non-missile penetrating injury is extremely rare. A 26-year-old male patient presented incomplete cauda equina syndrome due to a penetrating rebar wound from his perineal region to the lumbosacral spine. Computed tomography demonstrated a bony fragment broken from S1 body compressing into the spinal canal. RESULTS: By anterior approach, we performed partial corpectomy of L5, decompression by retrieving the bony fragment and L5-S1 interbody fusion. The patient had a significant recovery, and no clinical complication was found after over 2-year follow-up. CONCLUSION: It is challenging to determine the optimal strategy of surgical treatment for penetrating spinal injuries with retained foreign bodies, here we suggest an anterior approach situation that has the advantage of being able to effectively perform decompression and prevent iatrogenic damages of thecal sac and nerve rootlets.

Evaluation of stabbing assault injuries in a tertiary emergency department: a retrospective observational study.

BACKGROUND: Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED). METHODS: This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patient's files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients. RESULTS: Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3% (n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement. CONCLUSION: The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement.

Determining the manner of death in victims in drug-induced psychosis: a case of an atypical head stab wound.

This case report presents a rare case of an atypical head stab wound suffered by a drug addict and inflicted with a screwdriver during drug-induced psychosis. It describes the diagnostic and treatment procedures in the hospital and the findings of the subsequent autopsy. It also analyzes the review of the interpretation of the CT scans made upon admission and the subsequent treatment by an independent medical review panel, which revealed signs of medical mismanagement. Therefore, it also discusses the legal consequences that the case may have involved for the attending physicians in addition to the consequences for the suspected perpetrator. The report raises many issues encountered in the case in terms of the clinical treatment and forensic determination of the manner of death in cases of injuries caused by sharp instruments and highlights the importance of comprehensive evaluation of the circumstantial evidence together with the clinical or autopsy findings, since such evidence may sometimes be overlooked in clinical practice.

Application of 3D printing in assessment and demonstration of stab injuries.

In stabbing related fatalities, the forensic pathologist has to assess the direction of wound track (thus, the direction of the stabbing) and the weapon's possible characteristics by examining the stab wound. The determination of these characteristics can be made only with a high level of uncertainty, and the precise direction of the stabbing is often difficult to assess if only soft tissues are injured. Previously reported techniques used for the assessment of these wound characteristics have substantial limitations. This manuscript presents a method using today's easily accessible three-dimensional (3D) printing technology for blade-wound comparison and wound track determination. Scanning and 3D printing of knives is a useful method to identify weapons and determine the precise stabbing direction in a stabbing incident without compromising the trace evidence or the autopsy results. Ballistic gel experiment, and dynamic stabbing test experiments prove the method can be applied in safety, without compromising the autopsy results. Identification of the exact knife is not possible with complete certainty but excluding certain knives will decrease the number of necessary DNA examinations, hence it can lower the burden on forensic genetic laboratories. The method addresses many of the shortcomings of previously used methods of probe insertion or post-mortem CT. Insertion of the printed knife into the wound gives a good visual demonstration of the stabbing direction, thus easing the forensic reconstruction of the stabbing incident. After combining the 3D printing with photogrammetry, the achieved 3D visualization is useful for courtroom demonstration and educational purposes.

Evaluation of diagnostic laparoscopy for penetrating abdominal injuries: About 131 anterior abdominal stab wound.

BACKGROUND: The management of hemodynamically stable patients with anterior abdominal stab wounds (AASW) is debated. Mini-invasive techniques using laparoscopy and non-operative management (NOM) have reduced the rate of nontherapeutic laparotomies after AASW leading to unnecessary morbidity. The aim of this study was to determine with a systematic diagnostic laparoscopy of peritoneal penetration (PP), patients who do not require abdominal exploration in the management of stable patient with an AASW. METHODS: All patients with AASW were retrospectively recorded from 2006 to 2018. Criteria of inclusion were AASW patients who underwent a systematic diagnostic laparoscopy. Criteria of exclusion were patients with an evisceration, impaling, clinical peritonitis, and hemodynamic instability. If no PP was detected, laparoscopy was terminated. If defects of peritoneum were found, a laparotomy was performed looking for diagnosis and treatment of intra-abdominal injuries. RESULTS: On 131 AASW patients, 35 underwent immediate emergency laparotomy, 96 underwent diagnostic laparoscopy, 47 were positive (PP) and had an intra-abdominal exploration by laparotomy, 32 (68.1%) had intra-abdominal injuries which required treatment. All patients with an intra-abdominal injury had a positive diagnostic laparoscopy. For the 49 patients with a negative laparoscopy, the mean hospital stay was 1.6 days with ambulatory care for some patients. No patient presented a delayed injury. Non-therapeutic laparotomy rate was 15.6%. For patients who did not have an intra-abdominal injury the morbidity rate was low (3%). CONCLUSION: Our study shows that diagnostic laparoscopy was safe, with a low duration of hospitalization, a possible ambulatory care and had an excellent ability to screen the patients who did not need a abdominal exploration. This management can avoid many unnecessary laparotomies with an acceptable rate of negative laparotomy, without any delayed diagnosis of intra-abdominal injuries and with a low morbidity rate.

A cut throat: a case of C5-C8 brachial plexus root transection providing evidence of T1 innervation of thumb and finger extensors.

The T1 nerve root is not routinely thought of as innervating the extensors of the thumb and fingers. Work by Bertelli and Ghizoni proposed that the pattern of brachial plexus paralysis with intact hand function and thumb and finger extensors traditionally attributed to C5/6/7 root injury is in fact a C5/6/7/8 injury, with only T1 remaining intact - a 'T1 hand'. This case presents a 19-year-old male who was stabbed in the neck; exploratory surgery determined complete transection of the brachial plexus, with only the T1 nerve root remaining intact. Clinical examination demonstrated grade M4 pronation (with pronator quadratus), wrist extension (with extensor carpi ulnaris), thumb and finger extension (with extensor policis longus and brevis, extensor digitorum communis and extensor index proprius), wrist flexion (with palmaris longus), finger flexion (with flexor digitorum superficialis and profundus), thumb flexion (with flexor policis longus), and thenar and hypothenar muscles. Extensor carpi radialis longus and brevis, flexor carpi radialis and flexor carpi ulnaris were paralyzed. Triceps scored M2. This case provides unequivocal evidence that the T1 root provides significant innervation to the extrinsic thumb and finger extensors.

Evaluation of follow-up and long-term outcomes of gunshot and stab wounds in a French civilian population.

PURPOSE: The data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature. The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas. METHODS: This work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital, from January 2007 to January 2017. All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes. Epidemiological data, traumatism characteristics, hospital management, follow-up and traumatism consequences (i.e., persistent disability) were analyzed. To improve evaluation of traumatism long-term consequences, extra-hospital follow-up data from general physicians (GP) were collected by phone call. During this interview, 9 closed questions were asked to the GP. The survey evaluated: the date of the last consultation related to injury with the GP, the specific follow-up carried out by the GP, traumatism consequences, and recurrence of traumatism. Descriptive, univariate and multivariate with regression analysis were used for statistical analysis. RESULTS: A total number of 165 patients were included. Median (Q1, Q3) of hospital follow-up was 28 (4, 66) days. One hundred one patients (61.2%) went to their one-month consultation at hospital. GP follow-up was achieved for 76 patients (55.2%). Median (Q1, Q3) of GP follow-up was 47 (21, 75) months. Twenty-four patients (14.5%) have been totally lost to follow up. The overall follow-up identified 54 patients (32.7%) with long-term consequences, 20 being psychiatric disorders and 30 organic injuries. Organic consequences were mainly peripheral nerve damages (n = 20; 12.1%). Most of the psychiatric consequences were diagnosed during GP follow-up (n = 14; 70%). Seventeen cases (10.3%) of recurrence were found and late mortality occurred in 4 patients (2.4%). High injury severity score, older age and gunshot wound were significantly linked to long-term consequences. Data collection and analysis were carried out in accordance with MR004 reference methodology. CONCLUSION: This study showed a high rate of long-term consequences among patients managed for penetrating injury. If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians, most socio-psychiatric consequences were detected and followed by extra-hospital workers. However, for half of the patients, the extra-hospital follow-up could not be assessed. Thus, these consequences are very probably underestimated. It appears imperative to strengthen the compliance and adherence of these patients to the care network. Awareness and involvement of medical, paramedical teams and GP role seems essential to screen and manage these consequences.

Ruptured femoral artery pseudoaneurysm in drug abuser mimicking homicidal inguinal stab wound.

A 47-year-old woman with a long-term history of intravenous heroin use was found dead lying on the couch in a pool of blood with the wound in her right groin, 15 × 4 mm in diameter. The autopsy revealed the thickened superficial right femoral artery wall and the tract communication between the artery lumen and the skin surface, with pseudoaneurysm formation, confirmed by microscopic examination. Toxicological findings were negative for heroin and its metabolites. The cause of death was fatal blood loss from ruptured chronic femoral pseudoaneurysm. Persons with a long-term history of intravenous drug use experience injection-related problems: prominent vein scarring, lumps, and swelling. The risk of injecting the groin is substantially greater than in typical areas such as the cubital fossa. The proximity of the femoral vein to the femoral artery and nerve poses the risk of accidental trauma to these sites. Accidental groin arterial injections can cause a tear in the arterial wall, on which a pseudoaneurysm can develop. A false or pseudoaneurysm is a breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space. In the presented case, the autopsy findings pointed out that the fatal blood loss from femoral pseudoaneurysm rupture occurred probably after trivial trauma (shortly after sexual intercourse) or even spontaneously, and not immediately or shortly after arterial drug injection.

[Is thoracoscopic heart suturing possible for stab wounds?] / Vozmozhno li torakoskopicheskoe ushivanie rany serdtsa pri koloto-rezanom ranenii?

The authors report two clinical cases with similar stab wounds of the heart. The first patient underwent open wound closure, the second one - thoracoscopic suturing of the wound. The authors concluded that conversion may be unnecessary after diagnosis of heart injury if severe bleeding is absent.

[Morphological features of skin injuries caused by conducted energy weapons (CEWs)]. / Morfologicheskie osobennosti povrezhdenii kozhi, prichinennykh vystrelami iz distantsionnykh elektroshokovykh ustroistv.

The objective of the study is to identify, compare and analyze morphological features of skin injuries resulting from the experimental firing of various models of conducted energy weapons (CEWs) In the experimental study, the design features of the provided CEWs models and characteristics of skin injuries were studied using a simulator, a pig carcass, shot without a barrier point-blank, and at the distance of 0.5 cm, 5 cm, 50 cm, and 4.5 m. The results of expert and experimental studies showed differences in morphological features of skin lesions from two different CEW models with different designs. To make an objective expert conclusion on the kind of CEW used to damage the skin, distance, and angle to the target, it is necessary to perform appropriate experiments with at least two different models of these devices.

Transient astrocyte-like NG2 glia subpopulation emerges solely following permanent brain ischemia.

NG2 glia display wide proliferation and differentiation potential under physiological and pathological conditions. Here, we examined these two features following different types of brain disorders such as focal cerebral ischemia (FCI), cortical stab wound (SW), and demyelination (DEMY) in 3-month-old mice, in which NG2 glia are labeled by tdTomato under the Cspg4 promoter. To compare NG2 glia expression profiles following different CNS injuries, we employed single-cell RT-qPCR and self-organizing Kohonen map analysis of tdTomato-positive cells isolated from the uninjured cortex/corpus callosum and those after specific injury. Such approach enabled us to distinguish two main cell populations (NG2 glia, oligodendrocytes), each of them comprising four distinct subpopulations. The gene expression profiling revealed that a subpopulation of NG2 glia expressing GFAP, a marker of reactive astrocytes, is only present transiently after FCI. However, following less severe injuries, namely the SW and DEMY, subpopulations mirroring different stages of oligodendrocyte maturation markedly prevail. Such injury-dependent incidence of distinct subpopulations was also confirmed by immunohistochemistry. To characterize this unique subpopulation of transient astrocyte-like NG2 glia, we used single-cell RNA-sequencing analysis and to disclose their basic membrane properties, the patch-clamp technique was employed. Overall, we have proved that astrocyte-like NG2 glia are a specific subpopulation of NG2 glia emerging transiently only following FCI. These cells, located in the postischemic glial scar, are active in the cell cycle and display a current pattern similar to that identified in cortical astrocytes. Astrocyte-like NG2 glia may represent important players in glial scar formation and repair processes, following ischemia.

Penetrating Trauma in Baltimore: An Analysis of the Effect of a Rise in Localized Violence by Age Group.

BACKGROUND: Incidence of firearm mortality in the United States is increasing. Baltimore, MD saw a substantial increase in violence in April 2015. We analyzed the effect of this localized surge in violence on the pediatric population. METHODS: Using the Maryland Health Services Cost Review Commission database, initial hospital encounters for gunshot wound (GSW) or stab wound (SW) were identified. Baltimore Police Department victim-based crime data and homicide data on GSW and SW assault were used to capture those not seen at hospitals. Changes in incidence rate ratios from before/after April 2015 were analyzed using Poisson regression. RESULTS: No change in mortality was seen in hospital-evaluated GSW patients. The pediatric population showed decreased incidence of SW (P < 0.001) and increase in GSW (P < 0.001) but no change in total penetrating trauma (tPT). The young adult population had decreased SW incidence (P < 0.001) without change in GSW or tPT. The pediatric populations saw no difference in SW/GSW deaths or homicide rate. However, in young adults, there were increased homicides (P < 0.001) and GSW deaths (P < 0.001) with unchanged SW deaths. CONCLUSIONS: After a surge in violence, the shifted mechanism of penetrating trauma in the pediatric population did not increase mortality or tPT. By contrast, GSW incidence is increasing in young adults with more lethal injuries. Intervention could be aimed at gun control and targeted education/intervention in the at-risk younger age group.

Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent.

BACKGROUND: Although there is evidence that self-inflicted abdominal stab wounds are less severe than those from assault, it is unclear if this is true in other anatomic regions. This study compares severity and injury pattern between self-inflicted stab wounds (SISWs) and wounds from assault (ASW). MATERIALS AND METHODS: Stab wounds from our level I trauma registry from 2013 to 2018 were reviewed. Data included age, gender, self-inflicted versus assault, psychiatric or substance use history, anatomic location, operative intervention, injury severity, length of stay, and outcomes. RESULTS: Over the study period, 1390 patients were identified. History of psychiatric diagnoses or previous suicide attempts was more frequent in SISWs (47% versus 6.5%, P < 0.01; 35% versus 0.4%, P < 0.01). SISWs had a higher incidence of wounds to the neck and abdomen (44% versus 11%, P < 0.01; and 34% versus 26%, P = 0.02). Overall, injuries from ASW had a higher injury severity score, but more procedures were performed on SISWs (46% versus 34%, P < 0.01). SISWs to the neck were more likely to undergo procedures (26% versus 15%, P = 0.04). Median hospital charges were higher in patients with SISWs ($58.6 K versus $39.4 K, P < 0.01). CONCLUSIONS: SISWs have a distinct pattern of injuries, more commonly to the neck and abdomen, when compared with injuries resulting from ASW. The patients with SISWs have a higher rate of procedures, longer length of stay, and higher hospital charges despite low injury severity overall.

Yield of CT angiography in penetrating lower extremity trauma.

PURPOSE: CT angiography (CTA) has become a valuable tool in the assessment of suspected arterial injury in patients with penetrating lower extremity trauma. However, expensive imaging such as CTA should be judiciously utilized to ensure value-based care. We therefore assessed the yield of CTA in this setting at a level-1 trauma unit and correlated it with the clinical history provided. METHODS: A retrospective descriptive study from 1 July 2013 to 31 June 2018 at a 1386-bed, tertiary-level, public-sector teaching hospital in Cape Town, South Africa.. All patients undergoing CTA for suspected arterial injury following penetrating lower extremity trauma were included. The imaging yield of clinically significant arterial injury and the predictive value of specific clinical signs were determined. RESULTS: A total of 983 patients (median age 27 years, 91% male) were included; 90% (886/983) had gunshots, 9% (89/983) stabs, and 1% (8/983) other injuries. Despite an average 13% year-on-year increase in CTA performed, there was no change in the proportion demonstrating arterial injury. Thirty-four percent (23/68) of patients with strong (hard) signs of arterial injury (active pulsatile bleeding, rapidly expanding hematoma, absent pulse, palpable thrill, or audible bruit), 11% (49/459) with moderate (soft) signs (history of an arterial bleed, excessive non-pulsatile bleeding, large non-expanding hematoma, major neurological deficit, diminished but appreciable pulse, and arterial proximity), and 5% (24/456) with no indication for imaging had clinically significant arterial injuries. Significant positive correlations were rapidly expanding hematoma (p = 0.009), an absent pulse (p < 0.001), and a diminished pulse (p < 0.001). Significant negative correlations were proximity to a major artery (p = 0.005) and no clinical indication provided (p < 0.001). CONCLUSION: There is poor correlation between clinical details provided and the presence of arterial injury at our institution. In this context, CTA serves a pivotal role in the definitive identification of arterial injury.

Histone deacetylase inhibition promotes regenerative neurogenesis after stab wound injury in the adult zebrafish optic tectum.

The central nervous system (CNS) of adult zebrafish is capable of recovering from injury, unlike the CNS of mammals such as humans or rodents. Previously, we established a stab wound injury model of the optic tectum (OT) in the adult zebrafish and showed that the radial glial cells (RG) proliferation and neuronal differentiation contributes to OT regeneration. In the present study, we analyzed the function of histone deacetylases (HDACs) as potential regulators of OT regeneration. The expression of both hdac1 and hdac3 was found to be significantly decreased in the injured OT. In order to analyze the roles of HDACs in RG proliferation and differentiation after injury, we performed pharmacological experiments using the HDAC inhibitor trichostatin A. We found that HDAC inhibition after stab wound injury suppressed RG proliferation but promoted neuronal differentiation. Moreover, HDAC inhibition suppressed the injury-induced decline in expression of Notch signaling target genes, her4.1 and her6 after OT injury. These results suggest that HDACs regulate regenerative neurogenesis through changes in Notch target gene expression by histone deacetylation. HDACs and histone acetylation are promising molecular targets for neuronal regeneration and further studies about the molecular mechanisms behind the regulation of regeneration by histone acetylation are necessary.

A self-resolving, post-traumatic aortopulmonary shunt.

A 34-year-old Hispanic man sustained a stab wound to his chest complicated with hemopericardium and pericardial tamponade. He underwent emergent clamshell thoracotomy as well as repair to the pulmonary artery. A transthoracic echocardiogram showed no evidence of intracardiac shunt. Two months later, a new murmur was noted, with a transthoracic echocardiogram revealing high-velocity flow between the left coronary sinus and the main pulmonary artery, with which a coronary computed tomography angiogram concurred. A transesophageal echocardiogram was performed which revealed an aortopulmonic fistula from the left coronary sinus of Valsalva, approximately 1cm anterior to the ostium of the left main coronary artery, to the main pulmonary artery just distal to the pulmonic valve. Pulmonary insufficiency was minimal. The main pulmonary artery was dilated, measuring 3.2 cm by coronary computed tomography angiogram. Right ventricular systolic function was normal. Right and left heart catheterizations were performed to further assess hemodynamics and coronary anatomy; pulmonary artery pressures were 16/8 mm Hg. Aortopulmonary fistula was seen on aortogram. Surgery was deferred in view of lack of symptoms and uncertainty in its natural history in the setting of traumatic etiology. A repeat transthoracic echocardiogram at six-month follow-up showed spontaneous closure of the fistula.

Bacillus cereus bacteremia in a patient with an abdominal stab wound.

Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.

Trauma Recidivism and Mortality Following Violent Injuries in Young Adults.

BACKGROUND: Trauma recidivism accounts for approximately 44% of emergency department admissions and remains a significant health burden with this patient cohort carrying higher rates of morbidity and mortality. METHODS: A level 1 trauma center registry was queried for patients aged 18-25 y presented between 2009 and 2015. Patients with nonaccidental gunshot wounds, stab wounds, or blunt assault-related injuries were categorized as violent injuries. Primary outcomes included mortality and recidivism, which were defined as patients with two unrelated traumas during the study period. Hospital records and the Social Security Death Index were used to aid in outcomes. RESULTS: A total of 6484 patients presented with 1215 (18.7%) sustaining violent injuries (87.4% male, median age 22.2 y). Mechanism of violent injuries included 64.4% gunshot wound, 21.1% stab, and 14.8% blunt assault. Compared with nonviolent injuries, violent injury patients had increased risk of mortality (9.3% versus 2.1%, P < 0.0001). Out-of-hospital mortality was 2.6% (versus 0.5% nonviolent, P < 0.0005), with an average time to death being 6.4 mo from initial injury. Recidivism was 24.9% with mean time to second violent injury at 31.9 ± 21.0 mo; 14.9% had two trauma readmissions, and 8.0% had ≥3. Ninety percent of subsequent injuries occurred within 5 y, with 19.1% in the first year. CONCLUSIONS: The burden of injury after violent trauma extends past discharge as patients have significantly higher mortality rates following hospital release. Over one-quarter present with a second unrelated trauma or death. Improved medical, psychological, and social collaborative treatment of these high-risk patients is needed to interrupt the cycle of violent injury.

Utility of contrast-enhanced computed tomography in forensic examination of a stab wound in living individuals.

In cases of inflicted injury, the process of examining the patient for external injuries and documenting the findings is important for forensic assessment, including estimating or determining the type of weapon used and the circumstances of the violence. However, external examination is obviously limited in assessing internal injury. Here, we report the cases of two patients who survived stab wounds, where the findings of contrast-enhanced computed tomography (CT) performed for clinical diagnosis in the hospital were useful for forensic injury evaluation. In both cases, contrast-enhanced CT clearly displayed the injuries to the parenchymal organs and enabled the estimation of the direction and depth of the stab wounds by depicting the track and base of the wounds on acquired images. With the addition of the findings from examination of the external wound, the stab wounds in both victims were consistent with injury caused by the suspected weapon. Recently, imaging modalities including CT have become useful supplemental tools for precise forensic evaluation. Imaging findings obtained from these modalities could especially provide useful information for forensic assessment in clinical forensic medicine because examination of internal injury in the living body cannot generally be performed. Research on the precise diagnostic value of this method is required to utilize this method adequately in clinical forensic medicine.

Fatal delayed hemopericardium and hemothorax following blunt chest trauma.

Cardiac injury following blunt chest trauma is common in motor vehicle accidents due to a crush or blast injury. Severe cardiac trauma is associated with a very high mortality. If a cardiac injury develops several weeks after non-penetrating chest trauma, establishing a causal link between the traumatic event and the cardiac injury becomes complicated. This article reports a case of fatal delayed hemopericardium and hemothorax following a motor vehicle accident including blunt chest trauma 34 days prior to death. The cardiac injury was caused by displacement of a sharp irregular fragment of one of the decedents fractured ribs and the primary defect was sealed by blood clots. Subsequent bleeding occurred when the thrombus was displaced. Since the incidence of blunt high-energy chest injuries is relatively high, heart and large vessel injuries must be taken into account and a comprehensive examination needs to be done in order to prevent the delayed development of fatal complications.