First Case Report of the Use of Postmortem Wide-Angle Fundus Photography in Abusive Head Trauma
Toru Oshima1,2, Hiroshi Yoshikawa3, Hidehisa Sekijima2
1Department of Forensic Medicine, Nagoya City University, Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi.
Insights
Postmortem wide-field fundus photography using scanning laser ophthalmoscopy (SLO) can document retinal hemorrhages in fatal abusive head trauma (AHT) cases. This technique supplements traditional autopsy findings and may reduce specimen preparation artifacts.
Area of Science:
- Ophthalmology
- Forensic Pathology
- Pediatric Traumatology
Background:
- Retinal hemorrhages are a common finding in abusive head trauma (AHT).
- Wide-field fundus photography is standard for documenting retinal hemorrhages in living children.
- Pathologic examination is the traditional method for eye examination in fatal cases.
Purpose of the Study:
- To describe the utility of postmortem wide-field fundus photography using scanning laser ophthalmoscopy (SLO) in a fatal AHT case.
- To evaluate SLO as a supplementary diagnostic tool in forensic investigations of suspected child abuse.
Main Methods:
- A case study of a 4-year-old girl with suspected fatal AHT.
- Pre-autopsy wide-field fundus photography using SLO to document retinal hemorrhages.
- Autopsy and histopathologic examination of cranial and ocular tissues.
Main Results:
- SLO imaging revealed predominant retinal hemorrhages at the posterior pole and periphery of the right eye.
- Autopsy confirmed acute subdural hematoma and cranial injuries.
- Histopathology showed retinal hemorrhages within various retinal layers.
Conclusions:
- Postmortem SLO is a feasible technique for documenting retinal hemorrhages in fatal AHT.
- This method can supplement traditional pathologic findings and potentially minimize artifact.
- Further case studies are needed to establish the forensic application of postmortem SLO in AHT diagnosis.
Abstract:
Retinal hemorrhages commonly cooccur with abusive head trauma (AHT). While wide-field fundus photography is crucial for documenting retinal hemorrhage in living children, in fatal cases, a pathologic examination is traditionally used. This report describes the case of a 4-year-old girl who died of head trauma suspected to have been caused by physical abuse. Before the autopsy, wide-field fundus photography using scanning laser ophthalmoscopy (SLO) was performed to document retinal hemorrhages. Imaging revealed that retinal hemorrhages were predominantly located at the posterior pole and in the peripheral retina of the right eye. The autopsy confirmed cranial injuries, including acute subdural hematoma. Pathologic examination of the eyes revealed hemorrhages beneath the internal limiting membrane and within the inner to outer nuclear layers of the retina. The cause of death was determined to be head trauma leading to an acute subdural hematoma. This case confirms that wide-field fundus photography using SLO can be performed postmortem, supplementing pathologic findings. Postmortem fundus photography, particularly using SLO, has the potential to reduce the risk of artifact introduction during the preparation of traditional specimens. Additional case studies are required to further refine the use of this technique and establish its potential forensic application in the diagnosis of AHT.
