CT Scan Helped in A Crime Investigation!

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After a 49-year-old man, CT scan of the head and forensic examination helped in the criminal investigation by revealing the cause of head trauma and a potential crime weapon.

A 49-year-old man presented to the emergency department after he fell unconscious.  He was found lying on the floor. Physical examination in the emergency department revealed posttraumatic haemorrhagic lesions of the scalp. The doctors suspected injury to the head. Another differential was stroke; therefore, they immediately ordered a computed tomography (CT) scan of the head to rule out intracranial haemorrhage.

CT scan of the head revealed an extensive lesion on the right side of the skull, most probably due to a frontoparietotemporal craniectomy. Additionally, it also revealed a subarachnoid haemorrhage in the basal cisterns, cerebellopontine angle, and Sylvian fissure. Right side revealed a distinct, hyperdense, and streaky area lesion representing haemorrhage. It spanned from parietal cortex to the third ventricle.

CT scan
Non contrast CT head showing hemorrhagic focus on the right side.

Thereafter, the doctors performed a CT angiography to localise the bleeding source.

CT angiography:

CT angiography revealed Maximum Intensity Projection (MIP) images in the frontal plane. Since the haemorrhagic focus assumed a streaky shape, it strongly suggested that there is a high probability of a stab wound with a sharp instrument as the source of injury. Therefore, the team decided to perform a forensic examination of the scalp, which identified a linear incision 15mm from the margin of the craniectomy hole. The incision overlapped the periphery of the hyperdense focus relative to the hole. This confirmed the connection between the skin incision and the site of intracerebral bleeding.

CT angiography
CT angiography showing a hyperdense streak of blood, stretching from the subcutaneous layers to the III ventricle (arrows). Frontal plane (A) and sagittal plane (B), MIP reconstruction

These facts strongly suggested that the brain injury was not accidental, in fact, the police or the investigating team should find the potential crime instrument. From the results of the forensic examination, a knife which was found at the scene could now be connected to the crime. Previously, they did not link the knife to the crime. However, in the light of the imaging and forensics, the knife became a potential crime instrument since its blade size corresponded strictly to the streak of hyperdense blood.

Reference:

Banaszek A, Guziński M, Sąsiadek M. Computed tomography angiography reveals the crime instrument – case report. Pol J Radiol. 2010;75(2):98-100.

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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