Case 2025.01
Question: What are the findings and how do they confirm or refute the proposed mechanism of injury?
Skeletal injuries confirm the mechanism of injury.
The pattern of skeletal trauma supports the mechanism of a fall from significant height:
- Bilateral calcaneal fractures—commonly known as “Lover’s fractures” or “Don Juan fractures”, a classic indicator of high-impact falls onto the feet. (Images A & B).
- Compression fractures of the spine, consistent with axial loading forces from vertical impact. (Images C & D).
Case 2025.01.1
Question: What natural disease finding enhances visualization of his hepatic blunt force injuries?
An understanding of natural disease processes on PMCT is fundamental to accurate interpretation. In this case, underlying hepatic pathology enhances the conspicuity of blunt force trauma to the liver.
The low attenuation of the liver is consistent with underlying steatosis and/or fibrosis. This reduced density contrasts markedly with the high-attenuation blood products, allowing for clear identification of hepatic lacerations on PMCT.
Case 2025.02
Question: 78 year old found in a secure residence. LKA earlier the same day. What is the diagnosis?
Ruptured abdominal aortic aneurysms (AAA) can rapidly lead to fatal retroperitoneal hemorrhage. CT imaging plays a critical role in identifying the rupture site and associated bleeding patterns, even in non-traumatic deaths.
Case 2025.03
Question: 65-year-old found in secure home by partner. PMH of hypertension and diabetes. What is the diagnosis?
Answer: Diagnosis: Hemopericardium. Blood is present in the pericardial space. This case scenario may meet criteria for external examination at some offices. PMCT is diagnostic for hemopericardium. Furthermore, the hyperdense ring morphology of the hemopericardium—observed in this case—is significantly associated with antemortem hemorrhage, particularly in scenarios such as myocardial wall rupture following myocardial infarction. [1]
- Yamaguchi, R., et al., Fluid-Fluid Level and Pericardial Hyperdense Ring Appearance Findings on Unenhanced Postmortem CT Can Differentiate Between Postmortem and Antemortem Pericardial Hemorrhage. American Journal of Roentgenology, 2015. 205(6): p. W568-W577.
Case 2025.04
Question: What is the etiology of the hyperdensity along the right heart border (between the two yellow arrows) in this 12-month-old?
Answer: Thymus. (Outlined in yellow). Children are not little adults. This is an age-appropriate thymus in a 12-month-old who died of carbon monoxide poisoning. Misinterpreting a normal thymus as a mass or hemorrhage is a common error when interpreting pediatric imaging through an adult lens. Determination of normal from abnormal findings in the thymic bed on PMCT in the pediatric population is a fundamental skill[1, 2].
- Çolak, E. and B. Özkan, Multidetector Computed Tomographic Evaluation of the Normal Characteristics of the Thymus in the Pediatric Population. J Belg Soc Radiol, 2022. 106(1): p. 110.
- Abe, S., et al., Evaluation of thymic volume by postmortem computed tomography. Legal Medicine, 2015. 17(4): p. 251-254.
Case 2025.05
Question: 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.
Case 2025.06
Question: What artifact is demonstrated in this case?
ANSWER: Ring Artifact
Ring Artifact: Secondary to miscalibration or (most commonly) failure of detector elements. This typically occurs close to the isocentre of the scan and is usually visible on multiple slices at the same location. When related to the detector, you need to recalibrate or replace the detector. Artifact can degrade diagnostic accuracy.