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X-ray view of the hyoid-larynx complex in three cases with fatal trauma on the neck. a Case 1, anteroposterior projection shows fracture of the right greater horn of the hyoid bone and assumed fracture of the right superior horn of the thyroid (arrows). b Same case as in A, oblique projection, with better visualization of both fractures on the right (arrows). c Case 2, lateral projection shows fracture of right superior horn thyroid (arrow). d Case 3, oblique projection, detail, with fracture of the right superior horn of the thyroid (arrow)
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PurposeFatal trauma on the neck occurs frequent in forensic cases and often results in fractures of the hyoid-larynx complex. The aim of the present study is to provide an overview of fractures in the hyoid-larynx complex that occur due to fatal trauma on the neck and can be observed by radiological evaluation.Methods
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... HLC fractures present a significant diagnostic challenge for radiologists as they are rare, problematic to detect on CT of patients with an incompletely or non-ossified larynx, and difficult to differentiate from both old fractures and anatomical variants of the HLC (present in about 70% of individuals) [15][16][17][18]. The finding that all 6 HLC fractures in this study were fractures of the thyroid cartilage is in line with the literature on both non-fatal and fatal neck trauma: the thyroid cartilage is the most common site of HLC fractures, followed by fractures of the hyoid bone [15,17]. ...
... HLC fractures present a significant diagnostic challenge for radiologists as they are rare, problematic to detect on CT of patients with an incompletely or non-ossified larynx, and difficult to differentiate from both old fractures and anatomical variants of the HLC (present in about 70% of individuals) [15][16][17][18]. The finding that all 6 HLC fractures in this study were fractures of the thyroid cartilage is in line with the literature on both non-fatal and fatal neck trauma: the thyroid cartilage is the most common site of HLC fractures, followed by fractures of the hyoid bone [15,17]. ...
To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS.
The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre.
The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT.
The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations.
MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation.
• Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender.
• Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients.
• MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.
... The maximum possible correspondence between radiological and autoptic findings was observed with innovative postmortem fine preparation (PMFP) (10), which is a useful radiological support, especially in the context of the quantification of a trauma's extent, that is performed after organ explant (11). ...
... Suicides represent 65.6% of the 128 cases, homicides 31.25%, and accidents 3.1% in the fifteen analyzed studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)23). ...
... The six analyzed studies (8,9,11,12,14,20) did not have similar rates of hyoid bone lesions, as shown in the forest plot ( Fig. 4.a). The studies with a small sample presented low rates. ...
Background:
The diagnosis of neck lesions remains a medico-legal diagnostic challenge because of the complexity of the anatomical relationship of the neck's organs and their anthropometric morphological variability. We compared the multidisciplinary approach using autopsy and postmortem computed tomography (PMCT), postmortem fine preparation (PMFP), postmortem micro-computed tomography (micro-CT), and postmortem magnetic resonance (PMMR) with the performance of a single diagnostic method among them evaluating the significance of different results. The multidisciplinary approach significantly reduced the number of unidentified neck lesions. The analysis demonstrates the need to better define the scan protocols and compose forensic guidelines for radiological application. The results of this study point out the need to compare the different diagnostic approaches in deceased subjects to better define the radiological scan protocol based on a multidisciplinary approach, including autopsy and radiological methods and the radiological scan protocols.
Methods:
We performed a systematic electronic search of retrospective scientific articles in PubMed, the Scopus database, and the Cochrane Library. The following combinations of words were used: "hyoid fracture"; "comparison between PMCT AND autopsy"; "hyoid fracture PMCT AND autopsy"; "hyoid bone fracture AND forensic imaging"; "hyoid fracture AND PMCT"; "neck fracture PMCT AND autopsy"; "laryngohyoid lesions"; "postmortem CT AND autopsy in strangulation"; "postmortem AND strangulation Signs "; "strangulation virtopsy"; and "strangulation AND MRI". We selected 16 articles that were published between March 2003 and June 2020. We conducted a meta-analysis with R software to evaluate the rates. We obtained related confidence intervals and a forest plot.
Results:
Thyroid cartilage damages were significantly more common than hyoid bone fractures (61.7% vs 42.2%) in a sample of 128 subjects. The synergic uses of autopsy/PMCT, autopsy/PMFP, autopsy/microCT, and autopsy/PMMR revealed significantly higher rates than a single investigation. We analyzed the PMCT scan data. The scan parameters evaluated were as follows: row, scan sample, reconstruction, kernel, slice thickness, kVp, and mAs. A lack of uniformity in the application of the protocol was observed.
Conclusion:
Further studies are needed to better define the radiological scan protocols and to draw guidelines to identify the appropriate radiological methods in relation to the specific case.
Debates about illness, impairment, and injury in past groups are shaped by western notions of body schema and disability. However, bodily differences are more than just different cultural views where the body’s physical constraints are a given. For past groups, issues of embodied difference were ontologically contingent and co-constituted as immersed experiences. This chapter explores how “being-in-the-world” for Arroyo Hondo’s villagers was a multiplicity of worldly encounters shaped by the human body’s material conditions. By treating life histories as rhizomatic events, I explore embodied differences through the concepts of individuation, serial age collectives, and debility.
Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen’s Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.
