Post-mortem computed tomography as part of dental identification - a proposed guideline.

PURPOSE: This paper presents a proposed guideline for the use of post-mortem computed tomography (PMCT) during forensic dental identification. Currently, whole-body PMCT is widely used prior to autopsies for the diagnosis of fractures, organ changes, hemorrhages, and for the localization of foreign bodies, but it may also facilitate the odontological identification process in single cases and in cases involving multiple fatalities. Several studies have described the use of PMCT in forensic odontological work, but we have not found any comprehensive set of guidelines on how to perform a forensic odontological examination using PMCT. The aim was to develop guidelines for creating post-mortem dental charts during forensic odontological identification examinations using the standard functions of PMCT. METHODS: A proposed guideline was developed from 15 selected cases examined at the Section of Forensic Pathology, Department of Forensic Medicine at the University of Copenhagen in Denmark from October 2011 to May 2012. Using the functionalities and three-dimensional (3D) reconstructions of OsiriX DICOM-viewer software (Pixmeo Sarl, Bernex, Geneva, Switzerland) we adjusted the contrast and brightness settings and developed a proposed guideline for creating PMCT-based dental charts. A four-step guideline was produced. CONCLUSION: In our casework, we are currently using the guidelines proposed herein. The use of PMCT has allowed us to target our clinical examinations, greatly improving their efficiency. Furthermore, PMCT allows the storage of data for later documentation and research. Further research is needed to validate the proposed guideline.

[Diagnosing intracranial aneurysms in children can be difficult]. / Diagnosticering af intrakranialt aneurisme hos børn kan være vanskelig.

Intracranial aneurysms are rare in the paediatric population. They are distinct from classical adult aneurysms in having several special features. There is an overall male predominance and the dissecting aneurysms are the most frequent, followed by the saccular, the infectious and the post traumatic aneurysms. We present a case story of a 14-year-old Danish boy with an intracranial, giant, basilar artery aneurysm in. The autopsy was performed at the Forensic Department of Medicine in Copenhagen, Denmark. Prior to the autopsy, a routine computed tomography was performed, followed by a supplementary MRI scan.

[Tuberculosis caused by Mycobacterium africanum]. / Tuberkulose forårsaget af Mycobacterium africanum.

Tuberculosis (TB) is caused by pathogenic species within the Mycobacterium tuberculosis complex (MTBC). In the present case, a 40-year-old African man was admitted acutely. Despite negative microscopy, anti-TB treatment was initialized. Thirteen hours after hospitalisation, the patient suffered circulatory failure and died. Post mortem material from the lungs and pericardia tested positive for MTBC and was identified as Mycobacterium africanum by a new molecular method that enables identification of six of the eight MTBC species and provides clinicians with species-specific results.

[Cardiac arrest in child caused by button battery in the oesophagus and complicated by aorto-oesophageal fistula]. / Hjertestop hos barn som følge af knapbatteri i øsofagus kompliceret med aorto-øsofageal fistel.

Ingestion of button battery can result in serious complications if the battery becomes lodged in the oesophagus. We report a case of a 14-month-old child who died from exanguination due to aorto-oesophageal fistula caused by a lithium button battery lodged in the oesophagus. Recommendations concerning diagnostics, treatment and observations are described.

[De novo development of dyspnoea in a young healthy woman with fatal outcome]. / Nyopstået dyspnø med fatal udgang hos en ung, rask kvinde.

A 20-year old previously healthy woman who had been taking oral contraceptives for 2 years develops increasing dyspnoea, general ill-feeling and lower back pain over a matter of weeks. During this time she attends her general practitioner several times. She is primarily treated for what is interpreted as asthma and later for pneumonia due to the increase in CRP (C-reactive protein). Finally, she is admitted to hospital with severe dyspnoea, cyanosis, and un-measurable blood pressure. She is referred immediately to MR scan, but suffers heart arrest in bed. Twenty minutes' attempt to revival was in vain. Medicolegal obduction demonstrates severe double pulmonary embolism (saddle embolism). When a young previously healthy woman develops dyspnoea, the possibility of pulmonary embolism should be in mind because timely diagnosis and treatment is crucial for the prognosis. Oral contraceptives should be discontinued already at the suspicion of a pulmonary embolism as combined hormonal contraception has thrombogenic properties.