Age estimation by an analysis of spheno-occipital synchondrosis using cone-beam computed tomography

The spheno-occipital synchondrosis has a relatively late ossification in comparison with other cranial base synchondroses, which makes it a point of interest for forensic age determination studies. The purpose of the present study was to evaluate the reliability of spheno-occipital synchondrosis development in age determination in a Turkish population and to evaluate the reproducibility and reliability of cone beam computed tomography (CBCT) in an evaluation of the fusion stages of spheno-occipital synchondrosis. CBCT mid-sagittal images of 238 (90 males and 148 females) patients between the ages of 7 and 25, with a mean age of 15.45 ± 0.26 and 16.43 ± 0.37, respectively, were examined by three Oral and Maxillofacial Radiologists who evaluated the degree of synchondrosis fusion using a four-stage system. A reevaluation of 50 cases was conducted for intraobserver assessment. Multiple statistical analyses were used to assess the correlation between age and the fusion stage, to compare gender and age according to stages, and to evaluate the inter- and intraobserver agreement. The mean ages for complete fusion (Stage 3) were 18 and 20 for females and males, respectively. The interobserver agreement ranged between substantial and perfect, while the intraobserver agreement was substantial for all three observers. Based on these results, CBCT, when available, might be the method of choice for age estimation using the spheno-occipital synchondrosis fusion stages. Evaluating spheno-occipital synchondrosis has a value for age estimation around the age of 18 years, which affects the legal decisions in Turkey.     

Demonstrating the origin of cardiac air embolism using post-mortem computed tomography; an illustrated case

An 83 year old female was found dead in her home. The deceased had been struck repeatedly to the head with at least one weapon, one of which was a hammer. The deceased had suffered both penetrating and non-penetrating blunt trauma to the head as a result of the assault. A multi-detector computed tomography (MDCT) scan was undertaken approximately 12h after death prior to the autopsy examination. This demonstrated the presence of a cardiac air embolus and continuity between the air embolus and the penetrating head injury. Air within the heart is a recognised post-mortem artefact frequently seen on MDCT scans and a common pitfall for inexperienced cadaveric MDCT reporters. This case builds upon a previous report by Kauczor, illustrating how MDCT can be used to demonstrate the origin and route of ingress of a genuine air embolism to the heart.     

Correlation of computed tomography and postmortem findings of a diffuse astrocytoma: A case report

Diffusely infiltrating astrocytomas often present diagnostic difficulties. We herein correlate the radiologic and postmortem findings of a diffuse astrocytoma and conclude that recognition of abnormal bilateral and fairly symmetric enlargement and increased density of normal structures in CT scans may lead to an antemortem diagnosis of the tumor.     

Gunshot fatalities: Correlation between post-mortem multi-slice computed tomography and autopsy findings: A 30-months retrospective study

In this study we compared retrospectively the autopsy and the CT-scan findings in 47 gunshot victims (96 wounds) in order to assess the accuracy of the two methods in injury and ballistic diagnoses.Firing distance was determined in 46 wounds (47.9%). Firing range was determined by autopsy alone in 37 cases (80.5%) and by CT-scan alone in three cases (6.5%). In the six remaining cases (13%), autopsy and CT-scan reports concluded both to the same firing range. Entrance wounds were detected concordantly by both CT-scan and autopsy in 63 of the 91 penetrating wounds (69.2%). Exit wounds were present in 69 shots. They were concordantly detected by autopsy and CT-scan in 36 cases (52.2%). It was possible at CT imaging to determine the track of the bullet in up to 62 wounds (72.1%). CT-scan was superior to autopsy in determining two items: face fractures and pneumencephalon. CT scan was of limited value in demonstrating skull base fractures and contusions of the brain. There was good correspondence in demonstrating subarachnoid hemorrhage. CT-scan was accurate to demonstrate presence of gas, either in the pleural cavity (pneumothorax) or in the vessels’ lumen (air embolism). Both autopsy and CT-scan were concordant in demonstrating thoracic well injuries, heart lacerations and intra thoracic hemorrhage. CT-scan was far below autopsy in detecting solid organs injuries except for kidneys.The present survey shows that CT-scan is second to none in demonstrating features as pneumencephalon, facial fractures, midline shifts, air embolism, pneumothorax, and pelvic bones fractures. It may contribute to determine the firing range in cases of contact-range and of intermediate range though the firing range assessment remains beyond post-mortem imaging possibilities, at least at the current state of knowledge.     

Milk of calcium pericardial effusion confirmed with postmortem computed tomography and autopsy findings: A case report

We present the postmortem computed tomography and autopsy findings of a 60-year-old man who developed milk of calcium pericardial effusion and died of constrictive epicarditis. He experienced out-of-hospital cardiopulmonary arrest, and spontaneous circulation returned at the hospital. However, 7 h after recovery, the patient died. He had a swollen neck, had been experiencing coughing from 4 to 5 days earlier, and had no significant medical or surgical history. On computed tomography (CT), highly dense pericardial fluid (CT value: 130–150 Hounsfield units) and multiple calcifications along the epicardium and pericardium were visualized. The epicardium and pericardium were thick, hard, rough, and widely calcified with mild adhesions on autopsy. The pericardial cavity contained a pale, reddish brown, turbid, and highly viscous liquid. Bacteriological tests of pericardial fluid cultures revealed the presence of group G β-hemolytic streptococci. Hence, we diagnosed the patient’s cause of death as heart failure due to constrictive epicarditis. We believe that this case of milk of calcium pericardial effusion is the first case confirmed with postmortem CT and autopsy findings.     

Case report: computed tomography findings in spinal arachnoiditis ossificans

Spinal arachnoiditis ossificans is rarely diagnosed radiologically. We present such a case with its spinal computed tomography findings, the second such case reported in the radiology literature.     

Age estimation and the medial clavicular epiphysis: analysis of the age of majority in an Australian population using computed tomography

This study was designed in order to assess the suitability of clavicular development in discriminating whether or not an individual has reached the age of 18 years. The development of the medial clavicular epiphysis was examined in an Australian population using computed tomography as the imaging modality. The sample consisted of individuals who were admitted to the Victorian Institute of Forensic Medicine, Melbourne, Australia, for the purposes of medico-legal death investigation. Comparisons were made with similar studies conducted on different populations in other countries, which revealed that the Australian population reaches maturity earlier, and the level of left/right asymmetry is higher than in other studies. The high degree of variation in fusion times is discussed, and the consequent effect upon the ability to use this epiphysis as a tool for determining if an individual has reached the age of 18 years is analysed. If an individual in this population has completely fused clavicles at stage 5, then for males they will be at least 18 years of age, with a 99% certainty of being at least 21, and for females they will be at least 20 years old. If at stage three then an individual of either sex will be at least 17 years of age.     

Computed tomography findings of Crouzon syndrome: A case report

Crouzon syndrome is a genetic condition characterized by a premature fusion of skull sutures resulting in head and facial deformities. Crouzon syndrome is usually suspected at birth through physical examination or in the antenatal period via ultrasonographic assessment. Once Crouzon syndrome is suspected, advanced imaging methods such as three-dimensional computed tomography must be requested, showing early signs of cranial sutures fusion. In this paper, we present a case of a six-year-old girl who was taken to a pediatrician control appointment due to abnormal facies. During the physical examination, a suspicion of Crouzon syndrome was raised. Therefore, a head computed tomography was requested, showing asymmetrical calvarium thickening, diffuse indentation of the inner table of the skull, and moderate hydrocephalus with a big cyst in the posterior fossa. Due to these findings, the patient was remitted to maxillofacial surgery for further evaluation; however, the medical appointment could not be achieved as a consequence of the poor medical insurance of the girl. This paper aims to describe and discuss the computed tomography findings of Crouzon syndrome.     

Renal replacement lipomatosis: multidetector-row computed tomography findings in one case

Replacement lipomatosis of the kidney is the result of severe atrophy of the renal parenchyma often caused by chronic calculus disease with secondary marked benign proliferation of fibrofatty tissue replacing atrophied renal parenchyma. Different radiological modalities have been used to illustrate this entity, with magnetic resonance imaging, ultrasound, intravenous pyelogram, and computed tomography (CT) used most frequently. We report multidedector CT (MDCT) findings of replacement lipomatosis in a 50-year-old woman. We think that it accurately provides a complete one-step diagnostic workup and appropriate pre-surgical planning for patients for whom there is a suspicion of replacement lipomatosis.     

Focal liver lesions in multiple myeloma: ecography, computed tomography, and magnetic resonance findings. A case report

According to autopsy data, diffuse hepatic infiltration occurs in up to 50% of cases with multiple myeloma. However, focal infiltration (single or multiple), although exceptional, is also possible. Therefore, multiple myeloma should be included in the extensive differential diagnosis of space-occupying liver lesions. We present the case of a 71-year-old man diagnosed with multiple myeloma with multiple focal lesions in the liver and spleen studied by different imaging techniques (ultrasound, multi-phase computed tomography and magnetic resonance). The definitive diagnosis was made by immunohistochemical analysis of material obtained by US-guided fine needle aspiration. We review the imaging findings reported in the literature for focal liver lesions in multiple myeloma and in extramedullary plasmacytoma of the liver.     

Sex estimation of Malaysian sub-adults using craniometrics: A computed tomography study

Sex estimation is crucial in biological profiling of skeletal human remains. Methods used for sex estimation in adults are less effective for sub-adults due to varied cranium patterns during the growth period. Hence, this study aimed to develop a sex estimation model for Malaysian sub-adults using craniometric measurements obtained through multi-slice computed tomography (MSCT). A total of 521 cranial MSCT dataset of sub-adult Malaysians (279 males, 242 females; 0–20 years old) were collected. Mimics software version 21.0 (Materialise, Leuven, Belgium) was used to construct three-dimensional (3D) models. A plane-to-plane (PTP) protocol was utilised to measure 14 selected craniometric parameters. Discriminant function analysis (DFA) and binary logistic regression (BLR) were used to statistically analyze the data. In this study, low level of sexual dimorphism was observed in cranium below 6 years old. The level was then increased with age. For sample validation data, the accuracy of DFA and BLR in estimating sex improved with age from 61.6% to 90.3%. All age groups except 0–2 and 3–6 showed high accuracy percentage (≥75%) when tested using DFA and BLR. DFA and BLR can be utilised to estimate sex for Malaysian sub-adult using MSCT craniometric measurements. However, BLR showed higher accuracy than DFA in sex estimation of sub-adults.     

The use of post-mortem computed tomography in the investigation of intentional neonatal upper airway obstruction: an illustrated case

We present a single case report illustrating the diagnostic role of multi-slice computed tomography (MSCT) in the investigation of suspicious child death where mechanical asphyxia is suspected. The case illustrates how radiological findings that may not be observable on conventional plain X-ray were identified by post-mortem MSCT. We illustrate how MSCT can illustrate the position of a foreign body within the upper airway of a neonate without the need for in situ dissection and how the combination of post-mortem MSCT with skeletal survey can provide enhanced diagnostic information in the investigation of not only whether the child was liveborn but also the consideration as to whether or not death has been caused by upper airway obstruction.     

Evaluation of cerebral hemodynamics with computed tomography perfusion using gadolinium as an alternative to iodinated contrast: a case report

Computed tomography (CT) perfusion is traditionally performed using iodinated contrast, but this can be problematic in patients with impaired renal function or contrast allergy. We report a case of a 63-year-old man whose medical history was complicated by chronic renal failure, which was exacerbated after placement of a left cervical internal carotid artery stent by 70% stenosis and left hemisphere perfusion deficit. On a follow-up clinic visit, because of the patient s chronic renal failure, CT perfusion was performed successfully using gadolinium without further renal complications.     

Age estimation from pulp/tooth area ratio in maxillary incisors among Egyptians using dental radiographic images

Age estimation from dental radiographs is a non-destructive, simple method to obtain information. The aim of this study was to determine the reliability of age estimation from Egyptians' incisors radiographs. 144 periapical radiographs of maxillary (central & lateral) incisors (both sexes) aged 12-60 were used. Digital camera was used to image the radiographs. Images were computed and pulp/tooth area ratios were determined by AutoCAD Program. Data were subjected to correlation and regression analysis which showed statistically significant correlation (r?=?0.23 &P?=?0.006 for maxillary central incisors and r?=?-0.2 &P?=?0.05 for maxillary lateral incisors) between age and pulp tooth area ratio. Linear regression equations were determined separately for both central and lateral incisors along with the corresponding Standard Error of Estimate, which ranged from 1.2 to 5.08 years. Consequently, it was concluded that pulp/tooth area ratios of incisors are reliable for estimation of age among Egyptians in forensic work.     

Primary pancreatic lymphoma-diagnosed on computed tomography: A rare case report.

Primary pancreatic lymphoma is a rare disease. It comprises less than 0.5 % of pancreatic neoplasm and 0.1% of malignant lymphoma. It should be differentiated from pancreatic adenocarcinoma because management differs. At computed tomography, 2 types of morphology of primary pancreatic lymphoma have been described- a localized well-circumscribed tumoral form and another diffuse enlargement infiltrating or replacing most of the pancreatic gland. Here, we are presenting computed tomography (CT) imaging features of a case of primary pancreatic lymphoma in a 27 year old female who presented with a complaint of abdominal pain radiating to the back for 3 months and yellowish discoloration of sclera and skin for the last 15 days. In contrast-enhanced computed tomography an exophytic homogenously hypoenhancing mass arising from head and neck region of pancreas was seen. Involvement of common bile duct (CBD) and duodenum was there. The main pancreatic duct was not dilated. Common hepatic artery was encased by mass without arterial luminal narrowing or distortion. Diagnosis of primary pancreatic lymphoma was suggested on basis of imaging findings and further confirmed with fine-needle aspiration cytology.     

Adenocarcinoma in an ileal duplication cyst: ultrasound and computed tomography findings

A case of adenocarcinoma in an ileal duplication cyst is presented. The pathological and radiological findings are described. A review of the literature on this rare condition is discussed.     

Computed tomography findings in septic pulmonary embolism: A case report and literature review

This case report describes the findings of septic pulmonary embolism (SPE) in a young adult male with a history of intravenous drug use who initially presented with signs and symptoms of acute sepsis. The patient underwent evaluation by computed tomography (CT) imaging as well as blood cultures and echocardiography, which confirmed the diagnosis of SPE secondary to Staphylococcus aureus positive bacterial endocarditis. In this case report, we discuss the presentation and characteristic CT imaging findings of SPE as well as highlight the value of this imaging modality in the timely diagnosis and management of this urgent condition.     

Cerebellar hemorrhage with decreased absorption values on computed tomography: A case report

Summary A cerebellar hematoma verified at operation and autopsy had low absorption values on computed tomography (CT). We postulate that because of the patient's severe anemia, a low hemoglobin concentration in the hematoma itself resulted in its decreased absorption density. Reduction in hemoglobin or hematocrit of circulating blood may alter the usually diagnostic CT finding of high absorption values with intracerebral and cerebellar hemorrhage.     

Isolated dissection of the celiac trunk and its branches. X-ray computed tomography and angiography findings. A case report

A case of primary dissection of the celiac trunk in a young hypertensive patient is presented. The diagnosis, suspected by ultrasonography, was confirmed by angiography and CT which also allowed a study of the visceral complications. Appropriate surgical treatment was successfully carried out.