When the hidden features become evident: the usefulness of PMCT in a strangulation-related death

Asphyxia related-death is a common incident in forensic practice, since they can be related to suicide, homicide and accident. The deep structures of the neck can be very difficult to reach using the traditional neck dissection when no certain information about potential injuries are obtained. Furthermore in this kind of deaths no specific signs or injuries can be found at the external and internal examination of the body (such as the slight, if any, displacement of a body structure following a infraction and fissures, as well as injuries involving lamellae of the thyroid cartilage, cricoid cartilage, trachea). In recent years a great contribute to the field of postmortem diagnostics (e.g. gunshot wounds, sharp and blunt forces, etc.) has been given by the introduction of the post-mortem CT (PMCT); that is becoming a standard procedure performed before the traditional postmortem examination. In cases of asphyxia related-death (with special regards to homicidal strangulation) the PMCT with 3D documentation can be very helpful in revealing injuries on the small structures of the neck, that can be also masked by soft tissues and surrounding bleedings and provides a useful guide for the pathologist to choose the right dissecting technique and avoid artifacts or iatrogenic injury to delicate structures, such as hyoid bone or thyroid cartilage. The case of a homicide by ligature strangulation using two items (electric wire and cotton bed sheet) is presented, in which the PMCT was performed before the autopsy, showing helpful features concerning the mechanism of death.