Heat hematoma-like epidural collection mimicking traumatic hematoma in a reheated bathtub death

Prolonged immersion in a reheated bathtub can cause extensive thermal alteration and produce intracranial findings that mimic traumatic lesions on postmortem computed tomography (PMCT). Here, we report a bath-related fatality in a woman in her late 60s in which PMCT demonstrated a crescent-shaped epidural collection along the right parietal convexity. The collection exhibited layered components, consisting of a fat-attenuation upper layer and a dependent low-attenuation layer with a small amount of gas. PMCT also demonstrated diffuse bilateral ground-glass opacities, bilateral pleural effusions, and left pneumothorax, as well as fluid accumulation in the paranasal sinuses and airway fluid with foam. At autopsy, extensive epidermal stripping and blistering with heat rigor were observed, and red frothy fluid was present within the airway. Autopsy revealed a brick-colored epidural deposit (approximately 15 g) without skull fracture, consistent with heat-coagulated blood. Toxicological analysis detected triazolam and mirtazapine in the blood. Drowning was considered highly likely; however, definitive confirmation was limited by severe systemic thermal alteration. This case highlights a forensic diagnostic pitfall in which heat hematoma-like epidural changes following prolonged hot-water immersion may mimic traumatic epidural hematoma on PMCT, underscoring the importance of integrating scene information, toxicology, PMCT, and autopsy findings.