In this Through the Lens case, we examine a 62-year-old found in their secure residence during a wellness check. Dr. Jamie Elifritz highlights a large left subdural hematoma (red dotted outline) with rightward midline shift (green arrow) on PMCT, even in the setting of moderate decomposition.
Case: 62 y/o found in their secure residence during a wellness check. What is the diagnosis?
ANSWER: Diagnosis: Subdural hematoma in decomposed remains.
PMCT Brain Findings: Large left extra-axial hemorrhagic collection (red dotted outline) with rightward midline shift (signified by the green arrow). The Hounsfield Units (HU) measurement is included to demonstrate that the collection measures 92 HU (consistent with blood products).
The significance of the frontal head radiograph is that this case demonstrates imaging findings consistent with a moderate state of decomposition with extensive soft tissue gas.
Added Value of PMCT: PMCT allows the identification of fatal brain hemorrhage even in cases of progressive decomposition [1]. Patterns of hemorrhage on PMCT can help discriminate between the most common causes of intracranial hemorrhage (trauma, hemorrhagic stroke, hypertension and ruptured aneurysm)[2].
- Tappero, C., M.J. Thali, and W. Schweitzer, The possibility of identifying brain hemorrhage in putrefied bodies with PMCT. Forensic Sci Med Pathol, 2020. 16(4): p. 571-576.
- Baumeister, R., M.J. Thali, and G. Ampanozi, Postmortem radiological imaging of natural causes of death in adults – a review. Forensic Imaging, 2021. 26: p. 200473.
