Hanging : Postmortem Computed Tomography

Poster No.:

C-1846

Congress:

ECR 2011

Type:

Educational Exhibit

Authors:

Y. Kawasumi, Y. Hosokai, A. Usui, M. Sato, Y. Takane, H. Saito,

T. Ishibashi, M. Funayama; Sendai/JP

Keywords:

Forensic / Necropsy studies, CT, Diagnostic procedure, Forensics,

Trauma

DOI:

10.1594/ecr2011/C-1846

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Learning objectives
To illustrate the correlation between post-mortem forensic CT findings and the autopsy
results of hanging, and to outline the findings from hanging cases analysed through postmortem forensic CT scans.

Background
The use of post-mortem CT imaging is growing in forensic medicine [1-4]; however
differing findings have been reported between post-mortem and clinical CT. Thus, a direct
comparison of CT findings and autopsy results are necessary to establish the utility of
post-mortem CT in forensic medicine. Here, we performed a comparison of post-mortem
CT prior to forensic autopsy in hanging cases from May 2009 and illustrate and describe
the findings from these cases.

Imaging findings OR Procedure details

MDCT Scanning protocol

Aquilion 8 MDCT, Toshiba, Japan

120 kVp
Head: conventional scan, 4.0-mm slice thickness
Whole body: helical scan, 2.0-mm slice thickness

All cases underwent a conventional autopsy soon after CT. After receiving the autopsy
reports from forensic pathologists, the CT images were reviewed and the correlations
between CT findings and autopsy results were discussed.

Reconstructed 3D surface images can depict a ligature mark. The orientation of this
ligature mark is the key to identifying differences between typical hanging, atypical
hanging, and ligature strangulation.
A fracture of the hyoid bone and thyroid cartilage are additional clues to distinguish these
forms of hanging and strangulation. However, when the deviation of a bone fragment is
moderate, it is difficult to detect the fracture even on CT. For such a case, MR imaging
may be effective.

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Hanging
Typical Hanging
The remains are found in suspension. The ligature mark is bilaterally symmetric and
upward slope towards the back of the neck (Fig. 1: autopsy, Fig. 2: CT). The anterior
portion of the ligature mark is located between the hyoid bone and the prominence of the
thyroid cartilage in the majority of cases (Fig. 3: autopsy, Fig. 4: CT). The great horn of the
hyoid bone and the superior horn of the thyroid cartilage are pressed against the vertebral
body, and frequently fracture in cases of typical hanging. A fracture of the superior horn
of the thyroid cartilage (Fig. 5: autopsy, Fig. 6: CT) is more common in elderly people,
because the thyroid cartilage becomes calcified with age. A deviation of the hyoid bone
is also present in some cases (Fig. 7).
Atypical Hanging
All cases that do not correspond to typical hangings are defined as atypical hanging.
In such cases, the ligature mark is usually asymmetric or unilateral (Fig. 8: autopsy,
Fig. 9: CT). Fracture of the hyoid bone and thyroid cartilage is dependent on the site of
constriction (Fig. 10: autopsy, Fig. 11: CT).

Ligature strangulation
Generally, a ligature mark is located horizontally (Fig. 12: autopsy, Fig. 13: CT). The
appearance of the ligature mark changes depending on the type of ligature: e.g., the
ligature mark can be double or three-fold and hard ligature frequently creates friction
abrasion (Fig. 12). The level of constriction is typically below the hyoid bone; hyoid
bone fracture and deviation are uncommon. In comparison, thyroid cartilage fracture,
particularly of the superior horn, is occasionally present (Fig. 14: autopsy, Fig. 15: CT).

Images for this section:

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Fig. 1: Autopsy. The ligature mark is bilaterally symmetric and upward slope towards the
back of the neck (arrows).

Fig. 2: CT. The ligature mark is bilaterally symmetric and upward slope towards the back
of the neck (arrows).

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Fig. 3: Anterior portion of the ligature mark from autopsy (arrows).

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Fig. 4: Anterior portion of the ligature mark on CT (arrows).

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Fig. 5: Fracture of the superior horn of the thyroid cartilage from autopsy (arrowheads).

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Fig. 6: Fracture of the superior horn of the thyroid cartilage on CT (arrows).

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Fig. 7: Deviation of the hyoid bone on CT (arrow).

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Fig. 8: Asymmetric ligature mark from autopsy (arrows).

Fig. 9: Asymmetric ligature mark on CT (arrows).

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Fig. 10: Hyoid bone fracture from autopsy (arrowhead).

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Fig. 11: Hyoid bone fracture on CT (arrow).

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Fig. 12: Horizontal ligature mark with friction abrasion in autopsy (arrows).

Fig. 13: Horizontal ligature mark on CT (arrows).

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Fig. 14: Fracture of the superior horn of the thyroid cartilage from autopsy (arrowhead).

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Fig. 15: Fracture of the superior horn of the thyroid cartilage on CT (arrow).

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Conclusion
From postmortem forensic CT, hanging displays characteristic findings, including a
ligature mark, deviation of the hyoid bone, fracture of the hyoid bone, and fracture of the
superior horn of the thyroid cartilage. These findings may prove helpful in distinguishing
typical hanging, atypical hanging, and ligature strangulation.

Personal Information
Yusuke Kawasumi M.D. Ph.D.

Course of Radiological Technology

Department of Health Sciences
Tohoku University Graduate School of Medicine

References
1. R. Dirnhofer, C. Fackowski, P. Vock, et al. (2006) VIRTOPSY: Minimally invasive,
imaging-guided virtual autopsy. RadioGraphics 26:1305-1333
2. S. A. Bolliger, M. J. Thali, S. Ross, et al. (2007) Virtual autopsy using imaging: bridging
radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol
18:273-282
3. S. P. Stawicki, V. H. Gracias, S. P. Schrag, et al. (2008) The dead continue to teach
the living: examining the role of computed tomography and magnetic resonance imaging
in the setting of postmortem examinations. Journal of Surgical Education 65:200-205
4. E. Aghayev, L. Sraub, R. Dirnhofer, et al. (2008) Virtopsy - The concept of a centralised
database in forensic medicine for analysis and comparison of radiological and autopsy
data. Journal of Forensic and Legal Medicine 15:135-140

PATHOLOGY OF NECK INJURY

PETER VANEZIS

Page 16 of 17

BUTTERWORTHS

Forensic Pathology Reviews

Michael Tsokos
Humana Press

KNIGHT'S Forensic Pathology

Pekka J. Saukko, Bernard Knight
Edward Arnold

Page 17 of 17