Citation

Heimer J, Gascho D, Tappero C, Thali MJ, Zoelch N. Int. J. Legal Med. 2019; ePub(ePub): ePub.

Affiliation

Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00414-019-02190-2

PMID

31713679

Abstract

In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (¹H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and ¹H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ ¹H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer's acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.

Language: en

Keywords

Biofluids; Intravenous fluids; Postmortem computed tomography; Postmortem magnetic resonance imaging; Postmortem magnetic resonance spectroscopy