Forensic radiology practical under

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Forensic radiology practical under

  1. 1. By Ayman M Abdelfatah Assistant lecturer Department of Forensic Medicine – ASU 2009-2010
  2. 3. <ul><li>Diagnosis of hidden injuries </li></ul><ul><li>Diagnosis of hidden foreign bodies </li></ul><ul><li>Permanent record </li></ul><ul><li>Lacks emotional impact of photographs </li></ul>
  3. 5. <ul><li>It should be done: </li></ul><ul><ul><li>In every case of trauma </li></ul></ul><ul><ul><li>Before surgical interference or postmortem dissection </li></ul></ul>
  4. 6. <ul><li>I. Soft tissue injury: </li></ul><ul><ul><li>1-Swelling, edema or hemorrhage: Subdural hematoma around frontal lobe (arrows) on CT. </li></ul></ul>
  5. 7. <ul><li>I. Soft tissue injury: </li></ul><ul><ul><li>2-Laceration of an organ: knife wound to the heart (arrow) shown by MRI </li></ul></ul>
  6. 8. <ul><li>I. Soft tissue injury: </li></ul><ul><ul><li>3-Abnormal collection of air in the chest -> pneumothorax: Right-sided pneumothorax (arrow) on plain CXR </li></ul></ul>
  7. 9. <ul><li>I. Soft tissue injury: </li></ul><ul><ul><li>3-Abnormal collection of air in the chest -> pneumothorax: Left-sided pneumothorax (arrow) on CT scan of the chest with chest tube in place </li></ul></ul>
  8. 10. <ul><li>II. Fractures: </li></ul><ul><ul><li>1. Hidden fractures: </li></ul></ul><ul><ul><li>An infant who was hit in the back of the head with a blunt weapon, and sustained a separation of the odontoid process from the body of C2 with anterior subluxation of C1. Note separation of the spinous processes at the level of injury. </li></ul></ul>
  9. 11. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> skull </li></ul></ul></ul>
  10. 12. <ul><li>Skull fissures on plain XR </li></ul><ul><li>Skull fissures on CT </li></ul>
  11. 13. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> Long bones -> metaphyseal fractures (avulsion and dislocation of epiphyseal ends): Typical bucket-handle metaphyseal fracture of the distal humerus on plain XR. </li></ul></ul></ul>
  12. 14. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> Long bones -> metaphyseal fractures: </li></ul></ul></ul><ul><ul><ul><li>Corner fractures of the distal femur and proximal tibia </li></ul></ul></ul>
  13. 15. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> Long bones -> diaphyseal fractures: </li></ul></ul></ul><ul><ul><ul><li>Healing displaced transverse fracture of the femur in a 4-month-old abused infant </li></ul></ul></ul>
  14. 16. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> healed lateral rib fractures </li></ul></ul></ul>
  15. 17. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>A. Multiple regional fractures -> healed posterior rib fractures </li></ul></ul></ul>
  16. 18. <ul><li>II. Fractures: </li></ul><ul><ul><li>2. Battered child cases: </li></ul></ul><ul><ul><ul><li>B. Fractures of different ages: a new rib fracture (arrow) through one of the old, healed fractures. </li></ul></ul></ul>
  17. 19. <ul><li>III. Foreign bodies: stabbing by glass </li></ul>
  18. 20. <ul><li>III. Foreign bodies: Glass: A beer bottle was smashed against the right frontal area of this victim, producing a fracture (arrows) and shattering the bottle as well. A piece of the bottle penetrated the scalp and stuck in the outer table of the skull (open arrow). </li></ul>
  19. 21. <ul><li>III. Foreign bodies: broken blade: Broken knife in the face (arrows) </li></ul>
  20. 22. <ul><li>III. Foreign bodies: </li></ul><ul><li>Stab into the head. This is the second unsuccessful attempt to murder this victim. A preceding attempt has left a piece of wire (arrow) above and posterior to the sella. </li></ul>
  21. 23. <ul><li>III. Foreign bodies: bullets: </li></ul><ul><li>Fragmented bullet within the head and neck areas of a gunshot wound victim. </li></ul>
  22. 24. <ul><li>III. Foreign bodies: bullets: </li></ul><ul><li>A bullet traversed the posterior elements of the C-1 vertebra (small arrows), impacted on the posterior body of C-2 (open arrows), then dropped in the spinal canal before coming to rest at the C-5 level (large arrow). </li></ul>
  23. 25. <ul><li>III. Foreign bodies: shots: </li></ul><ul><li>A shotgun wound to the back injured the right kidney. The two pellets overlying the lower pelvis entered the urinary bladder (arrow) after passing through the right ureter. </li></ul>
  24. 26. <ul><li>III. Foreign bodies: Retained instruments after surgery: clamp </li></ul>
  25. 27. <ul><li>III. Foreign bodies: Retained instruments after surgery: curved needle (arrow) </li></ul>
  26. 28. <ul><li>III. Foreign bodies: Retained sponge after surgery </li></ul>
  27. 29. <ul><ul><li>I. Deductive identification: </li></ul></ul><ul><ul><ul><li>Sex: radiographs of skull, pelvis and sternum. </li></ul></ul></ul><ul><ul><ul><li>Age: </li></ul></ul></ul><ul><ul><ul><ul><li>Appearance of ossific centers </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Union of epiphysial plates </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Calcification of laryngeal and costal cartilages </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Skull radiographs for examination of fontanels, sutures and teeth. </li></ul></ul></ul></ul><ul><ul><ul><li>Race </li></ul></ul></ul><ul><ul><ul><li>Stature </li></ul></ul></ul>
  28. 30. <ul><ul><li>II. Comparative Identification: </li></ul></ul><ul><ul><li>Depends on comparing antemortem to postmortem X-Rays of a person. Comparison includes: </li></ul></ul><ul><ul><ul><li>Normal structures: comparison of skull sinuses especially frontal sinuses regarding the size and shape. </li></ul></ul></ul><ul><ul><ul><li>Abnormal structures: congenital anomalies of bones, deformities and/or fractures. </li></ul></ul></ul><ul><ul><ul><li>Dental radiographs: comparing root shapes, teeth fillings and abnormal teeth eruptions. </li></ul></ul></ul>
  29. 31. <ul><li>I. Addictive agents (body packer): </li></ul><ul><li>Abdominal radiograph of a body packer showing rounded and ovoid, slightly hyperdense packages, some of which are clearly surrounded by a halo of entrapped gas or air (some are marked with arrows). </li></ul>
  30. 32. <ul><li>I. Addictive agents (body packer): </li></ul><ul><li>CT images of a body packer shows multiple drug packages somewhat denser than the bowel, most of which contain entrapped air at the ends of the packages. </li></ul>
  31. 33. <ul><li>II. Jewels (larceny by ingestion): </li></ul><ul><li>Radiograph of the abdomen of a suspected jewel thief. Note the dense object (arrow) in the shape of a brilliant cut diamond. </li></ul>

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