Intra-abdominal packing: A radiologic challenge for forensic pathologists

摘要

A 53 year old man with a self-inflicted gunshot wound to the head was immediately transported to the hospital. After confirmation of brain death, he underwent surgery to donate his organs such as the liver and kidneys. A Post Mortem Computed Tomography (PMCT) scan was performed and interpreted by forensic pathologists. The fatal craniocerebral injuries were clearly visible on imaging. In addition, there was a large quantity of a low-attenuating laminar material interspersed with high-attenuating punctate to linear structures within the abdominal cavity ventrally to the displaced, not removed abdominal organs (Fig. 1). Autopsy revealed that these foreign materials corresponded to X-ray marked surgical, gauze, also known as surgical packing material (Fig. 2). Although x-ray marked gauze is easily recognized by radiologists and during traditional autopsy, forensic pathologists may be less familiar with imaging characteristics of packing material. This case may help forensic pathologists involved in forensic imaging to identify packing material on CT when assessing cases of medical error with retained foreign bodies in both the living and the dead.