Forensic Cases: Key Considerations in Emergency Radiology
PDF

Review

Forensic Cases: Key Considerations in Emergency Radiology

Turk Radiol Semin 2025;13(2):180-195 DOI: 10.4274/trs.2024.24153
,
PDF
Permissions

Abstract

The most common forensic cases in emergency radiology practice are patients admitted as a result of traffic accidents. Apart from injuries due to traffic accidents, other forensic cases that apply to emergency services are assault, injury with a firearm or sharp instrument and suicidal attempts. Imaging performed in these patients detects the presence of life-threatening conditions and affects the course of the forensic process. In gunshot wounds, the type of firearm, the characteristics of the bullet, the trajectory of the bullet and the elasticity of the tissues through which the bullet passes change the severity of the injuries. Penetrating injuries with knife/cutting tools are observed more frequently than firearm injuries. Cerebral ischemia, cervical vertebral fractures and hyoid bone or thyroid cartilage fractures can be detected in patients who are rescued in suicidal interventions due to hanging and admitted to the emergency department. Patients with acute drug-related complications due to increasing drug use in the world and in our country, and drug carriers (body packers) in body cavities are also forensic cases encountered in emergency radiology.

Keywords: Forensic radiology, body packing, laceration, ballistics, stab wound, assault, hanging

References

1

Balcı Y, Çolak B, Gürpınar K, Anolay NN. Türk ceza kanununda tanımlanan yaralama suçlarının adli tıp açısından değerlendirilmesi rehberi. Adli Tıp Kurumu. 2019.

2

Jha R, Pathak P, Koirala P, Maharjan B, Panthi S. Road traffic accidents presenting to the emergency department of a tertiary care center: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021; 59: 1081-5.

3

Harmancı P. Dünya’daki ve Türkiye’deki intihar olgularının sosyodemografik özellikler açısından incelenmesi. Hacettepe University Faculty of Health Sciences Journal. 2015.

4

Sodagari F, Katz DS, Menias CO, Moshiri M, Pellerito JS, Mustafa A, et al. Imaging evaluation of abdominopelvic gunshot trauma. Radiographics. 2020; 40: 1766-88.

5

Ditkofsky NG, Maresky H, Mathur S. Imaging ballistic injuries. Can Assoc Radiol J. 2020; 71: 335-43.

6

Pinto A, Russo A, Reginelli A, Iacobellis F, Di Serafino M, Giovine S, et al. Gunshot wounds: ballistics and imaging findings. Semin Ultrasound CT MR. 2019; 40: 25-35.

7

Truesdell W, Gore A, Primakov D, Lieberman H, Jankowska D, Joshi G, et al. Ballistic and penetrating injuries of the chest. J Thorac Imaging. 2020; 35: W51-9.

8

Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol. 2017; 24: 301-9.

9

Boleken ME, Dusak A, Günendi T, Kocaman OH, Kaya V, Dörterler ME. Bullet trajectory detection in the lung: multiplanar reformatted imaging of multidetector computed tomography in children. Ulus Travma Acil Cerrahi Derg. 2023; 29: 176-82.

10

Ketai L, Primack SL. Thoracic Trauma. 2019 Feb 20. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging [Internet]. Cham (CH): Springer ; 2019. Chapter 12.

11

Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg. 2019; 14: 56.

12

Kharytaniuk N, Bass GA, Salih A, Twyford M, O’Conor E, Collins N, et al. Penetrating stab injuries at a single urban unit: are we missing the point? Ir J Med Sci. 2015; 184: 449-55.

13

Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, et al. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol. 2020; 130: 109187.

14

Raptis DA, Bhalla S, Raptis CA. Computed tomographic imaging of cardiac trauma. Radiol Clin North Am. 2019; 57: 201-12.

15

Gopireddy DR, Kee-Sampson JW, Vulasala SSR, Stein R, Kumar S, Virarkar M. Imaging of penetrating vascular trauma of the body and extremities secondary to ballistic and stab wounds. J Clin Imaging Sci. 2023; 13: 1.

16

Kline-Fath BM, Seman JM, Zhang B, Care MM. Pediatric hanging and strangulation: is vascular injury a true risk? Pediatr Radiol. 2021; 51: 1889-94..

17

Gascho D, Heimer J, Tappero C, Schaerli S. Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy - a systematic review. Forensic Sci Med Pathol. 2019; 15: 84-92.

18

United Nations Office on Drug and Crime. World Drug Report 2023 (United Nations publication).

19

T.C. İçişleri Bakanlığı, Emniyet Genel Müdürlüğü, Narkotik Suçlarla Mücadele Daire Başkanlığı. Türkiye Uyuşturucu Raporu. 2022.

20

Bulakci M, Kalelioglu T, Bulakci BB, Kiris A. Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing. Eur J Radiol. 2013; 82: 1248-54.

21

Deitel M, Syed AK. Intestinal obstruction by an unusual foreign body. Can Med Assoc J. 1973; 109: 211-2.

22

Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M. Body packing: a review of general background, clinical and imaging aspects. Radiol Med. 2015; 120: 118-32.

23

Lo Re G, Argo A, Midiri M, Cattaneo C. Radiology in forensic medicine: from identification to post-mortem imaging. Springer ; 2020.

24

Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, et al. Radiological and practical aspects of body packing. Br J Radiol. 2014; 87: 20130500.

25

Schmidt S, Hugli O, Rizzo E, Lepori D, Gudinchet F, Yersin B, et al. Detection of ingested cocaine-filled packets--diagnostic value of unenhanced CT. Eur J Radiol. 2008; 67: 133-8.

26

Shahnazi M, Sanei Taheri M, Pourghorban R. Body packing and its radiologic manifestations: a review article. Iran J Radiol. 2011; 8: 205-10.

27

Tsang HKP, Wong CKK, Wong OF, Chan WLW, Ma HM, Lit CHA. Radiological features of body packers: an experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport. Hong Kong Journal of Emergency Medicine. 2018;25:202-10.

28

Mutlu OO, Aslan OC, Bingöl D, Kayadibi T. Soft tissue diseases associated with substance abuse. Eur Arch Med Res. 2014; 30: 129-33.

29

Dolinak D. Opioid toxicity. Acad Forensic Pathol. 2017; 7: 19-35.

30

Douedi S, Upadhyaya VD, Patel I, Mazahir U, Costanzo E, Hossain MA. Cocaine-induced giant bullous emphysema. Case Rep Med. 2020; 2020: 6410327.

31

Almeida RR, Zanetti G, Souza AS Jr, Souza LS, Silva JL, Escuissato DL, et al. Cocaine-induced pulmonary changes: HRCT findings. J Bras Pneumol. 2015; 41: 323-30.

32

Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I. Nasoseptal perforation: from etiology to treatment. Curr Allergy Asthma Rep. 2018; 18: 5.