Diagnostic accuracy of coronary artery stenosis and thrombosis assessment using unenhanced multiplanar 3D post-mortem cardiac magnetic resonance imaging.

BACKGROUND: A 3D sequence was introduced to unenhanced post-mortem cardiac magnetic resonance imaging (PMCMR) to enable multiplanar coronary artery image analysis and to investigate its diagnostic accuracy for the diagnosis of coronary artery stenosis and thrombosis. MATERIALS AND METHODS: N = 200 forensic cases with suspected coronary artery pathology underwent 3 Tesla PMCMR (sequence used: T2 weighted transversal 3D turbo spin echo) before autopsy. Main coronary artery stenosis and thrombosis were assessed in PMCMR by multiplanar image analysis by two observers. Coronary artery histology was determined as the gold standard and compared to PMCMR. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) with 95% confidence intervals were calculated. RESULTS: For all coronary arteries combined, sensitivity was 75% (PPV 73%) for the diagnosis of stenosis and 72% (PPV 71%) for the diagnosis of thrombosis. Specificity was 92% (NPV 90%) for correct diagnosis of non-existing stenosis and 97% (NPV 97%) for non-existing thrombosis. Sensitivity for correct diagnosis of different degrees of stenosis ranged between 67% and 80% (PPVs 67-82%); specificity ranged between 96% and 99% (NPVs 96-99%). CONCLUSION: Multiplanar PMCMR coronary artery stenosis and thrombosis assessment based on an unenhanced T2 weighted 3D sequence provide moderate sensitivity and high specificity for the diagnosis of coronary artery stenosis and/or thrombosis. Hence, 3D T2w PMCMR cannot reliably detect existing coronary artery stenosis and thrombosis but may be particularly useful for the exclusion of stenosis or thrombosis of the main coronary arteries.

Foot-Launched Flying Sport Fatalities in the Canton of Berne, Switzerland.

INTRODUCTION: Foot-launched flying sports such as paragliding, hang gliding, and speedflying are popular recreational activities that all pose a significant risk of accidents resulting in injuries or fatalities. We describe the epidemiology, incident circumstances, and findings of forensic examinations of fatalities in these sports. METHODS: In this retrospective analysis, we analyzed different parameters of paragliding, hang gliding, and speedflying fatalities in the canton of Berne, Switzerland, between 2000 and 2018. The data sources were police reports, forensic medical reports, the Swiss Hang Gliding Association, and the Swiss Council for Accident Prevention. RESULTS: In the given period, 40 incidents resulting in 42 fatalities were recorded (2 incidents involved 2-seaters). Three of the 40 incidents did not fulfill the inclusion criteria and were excluded. The deadliest phase was midflight. Collapse of the glider (n=9; 36%) was the leading cause of accidents among paraglider pilots. Multiple trauma (n=21; 54%) was the most frequent cause of death. In the forensic examination, all deaths (n=39) were assessed as accidents. CONCLUSIONS: The different categories of foot-launched flying sports varied in the causes of accidents and deaths. Fatalities in speedflying involved young pilots exposing themselves to high-risk situations. Fatalities may be prevented by enhancing education and training and promoting a cautious attitude among pilots.

How safe is BDSM? A literature review on fatal outcome in BDSM play.

A noteworthy number of people are interested in BDSM (bondage and discipline, dominance and submission, sadism, and masochism). Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49 years (mean age 34.9 years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.

3Tesla post-mortem MRI quantification of anatomical brain structures.

Quantitative post-mortem magnetic resonance imaging (PMMR) allows for measurement of T1 and T2 relaxation times and proton density (PD) of brain tissue. Quantitative PMMR values may be used for advanced post-mortem neuro-imaging diagnostics such as computer aided diagnosis. So far, the quantitative T1, T2 and PD post-mortem values of regular anatomical brain structures were unknown for a 3 Tesla PMMR application. The goal of this basic research study was to evaluate the quantitative values of post-mortem brain structures for a 3 T post-mortem magnetic resonance application with regard to various corpse temperatures. In 50 forensic cases, a quantitative PMMR brain sequence was applied prior to autopsy. Measurements of T1 (in ms), T2 (in ms), and PD (in %) values of cerebrum (Group 1: frontal grey matter, frontal white matter, thalamus, caudate nucleus, globus pallidus, putamen, internal capsule) brainstem and cerebellum (Group 2: cerebral peduncle, substantia nigra, red nucleus, pons, middle cerebellar peduncle, cerebellar hemisphere, medulla oblongata) were conducted in synthetically calculated axial PMMR brain images. Assessed quantitative values were corrected for corpse temperature. Temperature dependence was observed mainly for T1 values. ANOVA testing resulted in significant differences of quantitative values between the investigated anatomical brain structures in both groups. It can be concluded that temperature corrected 3 Tesla PMMR T1, T2 and PD values are feasible for characterization and discrimination of regular anatomical brain structures. This may provide a base for future advanced diagnostics of forensically relevant brain lesions and pathology.

Fatal strangulation during consensual BDSM activity: three case reports.

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed.

Diagnosis of pulmonary infarction in post-mortem computed tomography and post-mortem magnetic resonance imaging-a technical note.

Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease. Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction, we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1- and T2-weighted sequences.

Circumstances and causes of death of hikers at different altitudes: A retrospective analysis of hiking fatalities from 2003-2018.

INTRODUCTION: The number of hikers and the popularity of hiking in the Alpine region is great. Inevitably linked to this, natural deaths as well as fatal and non-fatal accidents occur. Nevertheless, there is little data available on hiking accidents in particular. This study examines the circumstances of accidents and the causes of death of hikers who have suffered fatal accidents. METHODS: Retrospectively, the police files and forensic medical reports of hiking fatalities in the Canton of Berne (Switzerland) from 2003 to 2018 were analyzed. In this process 25 predefined parameters were collected (e.g. manner of death, causes of death, height of fall). Subsequently, all fatal hiking accidents were evaluated and compared by altitude (<1800 m vs. >1800 m). RESULTS: 77 fatal hiking accidents were recorded in the given period, all of which were caused by a fall. Over 1800 m significantly more traumatic brain injuries occurred than under 1800 m (85 vs. 62.2 %, p = 0.022). Besides, significantly more accidents occurred during descent in the group above 1800 m than below 1800 m (60.9 vs. 84.8 %, p = 0.041). A large share of accidents occurred off official hiking trails (45.9 vs. 32.5 %). Significantly more equipment shortages were found in the group below 1800 m (32.4 vs. 12.5 %, p = 0.035). The accident victims with equipment shortages were on average 10.35 years younger. CONCLUSION: Causes and circumstances of death of hikers differ in some points significantly at different altitudes. Prevention in the form of education about the dangers of hiking off the official hiking trails and equipment shortages could prevent deaths in the future. The education should primarily be aimed at foreign, young and inexperienced hikers.

What happened before the run over? Morphometric 3D reconstruction.

In traffic accidents, the differentiation of run-over and other injuries is crucial because questions about the origin of fatal injuries often arise. It is sometimes difficult for forensic pathologists to answer them due to the superimposition of injuries or competing, potentially fatal findings. Therefore, using morphometric three-dimensional (3D) reconstructions offers new perspectives based on an interdisciplinary evaluation of all findings and traces. The morphometric 3D reconstruction includes the allocation of patterned injuries or transferred material, the determination of the origin of injuries as well as the reconstruction of the incident. The generated 3D models of persons, clothes, vehicles, incident sites and relevant objects resulting from forensic imaging, photogrammetry, 3D structured-light and laser scanning are included, as are all detected traces and damages. Three case studies are presented to illustrate the possibilities and results of morphometric 3D reconstruction. Run-over accidents have received less attention than the topic of pedestrian, bicycle and motorbike accident analysis for which there is a large body of literature. Our goal is to add to the understanding of run-over accidents using morphometric reconstruction in order to improve their analysis in the future. The possibilities of morphometric reconstructions by means of 3D techniques in run-over accidents are wide-ranging and can provide new, unexpected and significant insights.

Vital reactions - An updated overview.

The question whether an injury was sustained during life or not is one of the most important subjects in forensic medicine. Therefore, vital reactions have been a main research topic in forensic medicine for a long period and many renowned forensic pathologists have devoted important papers to this field. The research area ranges from macroscopically visible organ reactions, over tissue alterations (enzyme histochemistry, later on immunohistochemistry with a wide range of enzymes and other analytes, molecular pathology) to biochemical responses to injury. Especially in the field of immunohistochemistry and molecular pathology much progress has been achieved in the last years (e.g. heat-shock-proteins or positive aquaporine3-staining in mechanical skin trauma). Furthermore, 20 years after its implementation postmortem imaging also contributes to the detection and visualization of vital signs. The aim of the present review is to provide an update on forensically relevant vital signs/vital reactions. Systemic vital reactions especially of the circulatory and respiratory system as well as local vital reactions will be addressed. Vital reactions of different organ systems will be discussed in detail regarding pathogenesis and possible postmortem evolution. Current research on immunohistochemically detectable vital reactions (heat-shock-protein expression, aquaporine3-staining in mechanical trauma of the skin) will be addressed as well as biochemical vital reactions (agonochemical stress reaction, myoglobine in electrocution death, hypoxanthine as marker of hypoxia).

How Do Legal Experts Cope With Medical Reports and Forensic Evidence? The Experiences, Perceptions, and Narratives of Swiss Judges and Other Legal Experts.

Expert scientific knowledge, including medical knowledge, is relevant for the legal profession and can strongly influence rulings and sentencing in criminal law, civil law, and insurance law. The way in which this medical evidence is understood and evaluated thus has an impact both on individuals and on society as a whole. It enters legal procedures in various forms, for example, as expert witness statements and/or as a legal expert's own acquired medical knowledge. On the other hand, a legal expert may be confronted with expert medical opinions that differ in quality or content and thus have to decide which ones to follow. The aim of this qualitative study was to investigate legal experts' perceptions, experiences, and narratives regarding medical knowledge, particularly the skills and general knowledge used in their branch of the legal profession. A total of 51 semi-structured interviews with judges and prosecutors from different courts of law and from the public prosecutor's office in six different German-speaking (Zurich, Luzern, Aagrau, Obwalden, Nidwalden, Zug) and German/French-speaking (Bern) cantons of Switzerland were conducted, coded, and analyzed using Nvivo. We used a comparison thematic approach identifying common and new themes related to the research aims. Our findings suggest that Swiss judges and prosecutors believe that possessing and developing the skills and terminology required for processing medical information is important but complex, and time-consuming for their work. Additionally, several legal experts reported that their understanding of medical evidence was limited or even non-existent. Moreover, the acquisition of skills related to the assessment of medical reports and forensic evidence appeared to be unstructured. Participants reported having no formal instruction in how to evaluate or deal with medical knowledge. The sources they used to answer questions arising appeared to be in part problematic and non-standardized (internet, newspapers, etc.). Medical literature from peer-reviewed journals was used only rarely. The findings from this study suggest that law departments might wish to evaluate whether their graduates are sufficiently equipped with scientific literacy skills and appropriate skills to evaluate medical information for their later careers. At the same time, medical knowledge pertinent to forensics published in local legal journals may be more effective in reaching the legal expert audience than in medical journals.

Hounsfield unit values of liver pathologies in unenhanced post-mortem computed tomography.

BACKGROUND: The goal of this study was to evaluate if unenhanced PMCT HU values of liver pathologies differ from post-mortem HU values of non-pathologic liver tissue. METHODS: Liver HU values were measured in five liver segments in PMCT unenhanced datasets of 214 forensic cases (124 male, 90 female, mean age 54.3 years). Liver HU values were compared with corresponding histologic liver findings. HU values of non-pathologic livers were compared to HU values of liver pathologies. RESULTS: A total of 64 non-pathologic livers (mean HU 58.32, SD 8.91) were assessed. Histologic diagnosed liver pathologies were as follows: steatosis (n = 121 (grade I n = 61, grade II n = 37, grade III n = 23)), fibrosis (n = 10), and cirrhosis (n = 19). HU values of the livers exhibiting severe steatosis (mean HU 32.44, SD 13.76), fibrosis (mean HU 44.7, SD 16.31), and cirrhosis (mean HU 50.59, SD 9.42) significantly differed to HU values of non-pathologic livers at ANOVA testing. CONCLUSION: PMCT unenhanced liver HU value measurements may be used as an additional method to detect unspecific liver-pathology. Values below 30 HU may specifically indicate severe steatosis.

Layering of stomach contents in drowning cases in post-mortem computed tomography compared to forensic autopsy.

BACKGROUND: In forensic autopsy, the analysis of stomach contents is important when investigating drowning cases. Three-layering of stomach contents may be interpreted as a diagnostic hint to drowning due to swallowing of larger amounts of water or other drowning media. The authors experienced frequent discrepancies of numbers of stomach content layering in drowning cases between post-mortem computed tomography (PMCT) and autopsy in forensic casework. Therefore, the goal of this study was to compare layering of stomach contents in drowning cases between PMCT and forensic autopsy. METHODS: Drowning cases (n = 55; 40 male, 15 female, mean age 45.3 years; mean amount of stomach content 223 ml) that received PMCT prior to forensic autopsy were retrospectively analyzed by a forensic pathologist and a radiologist. Number of layers of stomach content in PMCT were compared to number of layers at forensic autopsy. RESULTS: In 28 of the 55 evaluated drowning cases, a discrepancy between layering of stomach contents at autopsy compared to PMCT was observed: 1 layer at autopsy (n = 28): 50% discrepancy to PMCT, 2 layers (n = 20): 45% discrepancy, and 3 layers (n = 7): 71.4% discrepancy. Sensitivity of correctly determining layering (as observed at forensic autopsy) in PMCT was 52% (positive predictive value 44.8%). Specificity was 46.6% (negative predictive value 53.8%). In a control group (n = 35) of non-drowning cases, three-layering of stomach contents was not observed. CONCLUSION: Discrepancies of observed numbers of stomach content layers between PMCT and forensic autopsy are a frequent finding possibly due to stomach content sampling technique at autopsy and movement of the corpse prior to PMCT and autopsy. Three-layering in PMCT, if indeed present, may be interpreted as a hint to drowning.

Individual synthetic head models in wound ballistics - A feasibility study based on real cases.

Synthetic models, also called "surrogates", are commonly used in wound ballistics in order to simulate human tissues. Despite several surrogates are worldwide accepted and used; some of them have not been yet fully validated and their limits for forensic reconstructions have not been deeply investigated yet. In this work we present a homicide/suicide case involving three gunshots to the head with bullets retained in the skull or beneath the scalp. Reconstruction of these cases was performed preparing three individual synthetic head models based on post-mortem computed tomography (PMCT) measurements. Ballistic soap, polyurethane plates and 10% ballistic gelatine at 4°C were used as simulants in individually adapted thickness. Ballistic tests were performed using the questioned firearm and ammunition type. The damages on the synthetic models have been compared to the findings in PMCT and autopsy of the victims. Although the results highlighted general similarities in terms of injury characteristics, some of the experimental shots overpenetrated. Furthermore, the bullets recovered in the synthetic models did not show the same quality of deformations as the questioned bullets. This lack of bullet deformation in the synthetic models might be mainly attributed to the physical difference between real bones and polyurethane surrogate.

A preliminary study about the spatiotemporal distribution of forensically important blow flies (Diptera: Calliphoridae) in the area of Bern, Switzerland.

To assess the species composition of necrophagous blow flies (Diptera: Calliphoridae) in the area around the federal city of Switzerland, Bern, sampling with baited bottle traps was performed over the course of 34 weeks in 2014. Six locations ranging from urban to forest habitats were sampled weekly or rather biweekly in the winter period. 5580 individuals belonging to 16 species were identified with Lucilia sericata as the most dominant and frequent species, followed by Calliphora vicina. While most individuals were found in the urban habitats, species richness was highest in the forest. Species richness and Chao-Shen entropy estimator peaked in most locations in the summer. In winter only two species were documented (C. vicina, Calliphora vomitoria). The species Lucilia illustris was found to be an indicator species for summer and autumn, while C. vomitoria was found to be an indicator species for the forest location. Entomological cases of the same time period conducted in the Institute of Forensic Medicine Bern were included to compare the species composition. Six blow fly species were found on human bodies which are in line with the monitoring. Of these, L. sericata, C. vicina and Protophormia terraenovae were the most frequent.

Temperature-corrected postmortem 3-T MR quantification of histopathological early acute and chronic myocardial infarction: a feasibility study.

The goal of the present study was to evaluate if quantitative postmortem cardiac 3-T magnetic resonance (QPMCMR) T1 and T2 relaxation times and proton density values of histopathological early acute and chronic myocardial infarction differ to the quantitative values of non-pathologic myocardium and other histopathological age stages of myocardial infarction with regard to varying corpse temperatures. In 60 forensic corpses (25 female, 35 male), a cardiac 3-T MR quantification sequence was performed prior to autopsy and cardiac dissection. Core body temperature was assessed during MR examinations. Focal myocardial signal alterations in synthetically generated MR images were measured for their T1, T2, and proton density (PD) values. Locations of signal alteration measurements in PMCMR were targeted at heart dissection, and myocardial tissue specimens were taken for histologic examinations. Quantified signal alterations in QPMCMR were correlated to their according histologic age stage of myocardial infarction, and quantitative values were corrected for a temperature of 37 °C. In QPMCMR, 49 myocardial signal alterations were detected in 43 of 60 investigated hearts. Signal alterations were diagnosed histologically as early acute (n = 16), acute (n = 10), acute with hemorrhagic component (n = 9), subacute (n = 3), and chronic (n = 11) myocardial infarction. Statistical analysis revealed that based on their temperature-corrected quantitative T1, T2, and PD values, a significant difference between early acute, acute, and chronic myocardial infarction can be determined. It can be concluded that quantitative 3-T postmortem cardiac MR based on temperature-corrected T1, T2, and PD values may be feasible for pre-autopsy diagnosis of histopathological early acute, acute, and chronic myocardial infarction, which needs to be confirmed histologically.

Impact energy of everyday items used for assault.

Blunt force is a frequently used type of violence especially because it can be performed with basically every object of our daily lives or with bare hands or feet. The injuries and medical consequences have been widely examined, whereas the forces and especially the energies acting on impact have rarely been analyzed. The aim of the present study is to provide the impact energy and its ranges of four longish everyday items with different characteristics for male and female offenders. Additionally, the moment of inertia (MOI) for all the objects was calculated and its influence on the energy determined. A combination wrench, aluminum pipe, golf club, and spade were chosen as representatives of the four categories short, medium length with the center of mass (COM) in the middle, medium length with the COM close to the hitting point, and long and heavy. A total of 880 strikes have been performed by 11 volunteers. The results show the mean energy values of wrench, pipe, golf club, and spade for men of 51.1, 74.4, 93.5, and 166.7 J. For women, the results are 33.0, 41.0, 56.5, and 76.8 J. Knowing the energy thresholds for certain fractures and injuries, these results help to assess whether a claimed hit may have caused the fracture or injury or not.

The Sommersdorf mummies-An interdisciplinary investigation on human remains from a 17th-19th century aristocratic crypt in southern Germany.

Sommersdorf Castle (Bavaria, Germany) is a medieval castle complex which has been inhabited by the aristocratic family von Crailsheim. The deceased were entombed in a crypt located in the parapets underneath the castle's church, resulting in mummification of the bodies. Based on the family chronicle and oral history, identities have been ascribed to the mummies. The aim of the study is therefore to test the accuracy of the historical records in comparison to archaeological, anthropological and genetic data. Today, the crypt houses eleven wooden coffins from the 17th to 19th century AD. In ten of these, mummified and scattered human remains were found. Archive records were studied in order to identify names, ancestry, titles, occupation, date of birth and death, and place of interment of the individuals. The coffins were visually inspected and dated by typo-chronology, and the mummified and scattered skeletal remains were subjected to a physical anthropological examination. In total, the crypt contains the remains of a minimum number of nine individuals, among them three adult males, five adult females and one infant. A detailed scientific examination, including prior conservation, ancient DNA analyses, and computed tomography (CT), was performed on five mummies. By means of the CT data age at death, sex, body height, pathologies, and anatomical variants were investigated. CT analysis further showed that the bodies were naturally mummified. Mitochondrial DNA analyses revealed that the tested individuals are not maternally related. In addition, health, living conditions and circumstances of death of the entombed individuals could be highlighted. Being confronted with the strengths, weaknesses and limitations of each methodological approach, probable identification was achieved in two cases.

Temperature-corrected post-mortem 1.5 T MRI quantification of non-pathologic upper abdominal organs.

OBJECTIVES: The present study aimed to evaluate if simultaneous temperature-corrected T1, T2, and proton density (PD) 1.5 T post-mortem MR quantification [quantitative post-mortem magnetic resonance imaging (QPMMRI)] is feasible for characterizing and discerning non-pathologic upper abdominal organs (liver, spleen, pancreas, kidney) with regard to varying body temperatures. METHODS: QPMMRI was performed on 80 corpses (25 females, 55 males; mean age 56.2 years, SD 17.2) prior to autopsy. Core body temperature was measured during QPMMRI. Quantitative T1, T2, and PD values were measured in the liver, pancreas, spleen, and left kidney and temperature corrected to 37 °C. Histologic examinations were conducted on each measured organ to determine non-pathologic organs. Quantitative T1, T2, and PD values of non-pathologic organs were ANOVA tested against values of other non-pathologic organ types. RESULTS: Based on temperature-corrected quantitative T1, T2, and PD values, ANOVA testing verified significant differences between the non-pathologic liver, spleen, pancreas, and left kidneys. CONCLUSIONS: Temperature-corrected 1.5 T QPMMRI based on T1, T2, and PD values may be feasible for characterization and differentiation of the non-pathologic liver, spleen, pancreas, and kidney. The results may provide a base for future specific pathology diagnosis of upper abdominal organs in post-mortem imaging.

Post-mortem CT: Hounsfield unit profiles obtained in the lungs with respect to the cause of death assessment.

Segmentation of the lungs using post-mortem computed tomography (PMCT) data was so far not feasible due to post-mortem changes such as internal livores. Recently, an Osirix plug-in has been developed allowing automatically segmenting lungs also in PMCT data. The aim of this study was to investigate if the Hounsfield unit (HU) profiles obtained in PMCT data of the segmented lung tissue present with specific behaviour in relation to the cause of death. In 105 PMCT data sets of forensic cases, the entire lung volumes were segmented using the Mia Lite plug-in on Osirix. HU profiles of the lungs were generated and correlated to cause of death groups as assessed after forensic autopsy (cardiac death, fatal haemorrhage, craniocerebral injury, intoxication, drowning, hypothermia, hanging and suffocation). Especially cardiac death cases, intoxication cases, fatal haemorrhage cases and hypothermia cases showed very specific HU profiles. In drowning, the profiles showed two different behaviours representing wet and dry drowning. HU profiles rather varied in craniocerebral injury cases, hanging cases as well as in suffocation cases. HU profiles of the lungs segmented from PMCT data may support the cause of death diagnosis as they represent specific morphological changes in the lungs such as oedema, congestion or blood loss. Especially in cardiac death, intoxication, fatal haemorrhage, hypothermia and drowning cases, HU profiles may be very supportive for the forensic pathologist.