Postmortem inspection is a specialized medical practice that determines the cause and manner of death via external examination of a corpse. It is performed as part of the medico-legal death investigation and a crucial step in determining whether an autopsy is necessary. In South Korea, training for doctors performing postmortem inspection and quality control for postmortem inspection results remain lacking. Therefore, the Korean Society for Legal Medicine established a task force and proposed a standard operating procedure (SOP) of postmortem inspection. This article includes the background for proposing this SOP, an introduction to the postmortem inspection process, and the principles for performing the procedure and writing the report. This SOP may serve as a basic guideline for postmortem inspection.

A deceased individual’s time of death is crucial for solving crimes, but its accurate estimation remains limited. This is a major research topic in forensic medicine, and various methods have been attempted. Recently, cases in which pulse recordings from smartwatches were used to determine the time of death and aid in case resolution have been reported. Photoplethysmography, a technology that measures pulse, is applied to most smartwatches and its accuracy is clinically recognized. However, further research is needed before it can be applied to forensic medicine to estimate the time of death. Here, we report the autopsy case of a 50-year-old man who died in his sleep and whose time of death was estimated based on cardiac arrest detected on a smartwatch., along with a literature review.

Fat embolism syndrome is a rare but potentially fatal complication that can occur after major trauma, long-bone fracture, or orthopedic surgery. Symptoms typically manifest 24–72 hours after the initial injury. However, in patients with severe underlying disease, the disease course can be aggressive and occasionally fatal within hours. This report presents an autopsy-confirmed case of rapidly progressive fat embolism syndrome after a femoral fracture in a patient with severe idiopathic pulmonary fibrosis. The patient experienced progressive respiratory distress within two hours of the fracture and died five hours post-injury. Postmortem examination revealed advanced pulmonary fibrosis and clear evidence of a systemic fat embolism.

Myiasis, a parasitic infestation caused by dipteran larvae in living humans or animals, is rarely encountered postmortem. Here, we report a case of myiasis identified during postmortem inspection in a 40-year-old man with a 10-year history of untreated schizophrenia. During the winter between late 2022 and early 2023, the decedent walked outdoors barefoot and sustained frostbite and was advised to undergo limb amputation at a university hospital in March 2024. He died at home in late May 2024. At the scene, the body showed displaceable livor mortis and absence of rigor mortis, suggesting a short postmortem interval. Severe necrosis was present below the knees, and numerous third-instar larvae without postfeeding stage were observed within the necrotic tissue, suggesting myiasis development at the frostbite sites. Species identification via larval sampling was not possible; thus, photographic analysis was attempted. The larva at the most advanced developmental stage was most likely a third-instar Lucilia sericata, the most common species causing myiasis in Korea. Assuming a skin temperature of 34°C under blanket coverage, the estimated post-oviposition interval ranged from 38.9–71.7 hours. Considering the estimated postmortem interval, the oviposition may have occurred antemortem. Since myiasis can indicate neglect or contribute to death, forensic pathologist should assess whether the postmortem interval aligns with the developmental stage of the larvae. For accurate forensic entomological analysis, adequate sampling of larvae is essential during postmortem inspections.

Here, we report the fatal case of an 83-year-old woman who died after ingesting a Chinese preparation containing aminopyrine and caffeine. The combined toxic mechanisms of these drugs were examined from a forensic toxicological perspective. Postmortem peripheral blood analysis revealed lethal concentrations of aminopyrine (369.66 mg/L) and caffeine (134.19 mg/L). Aminopyrine induces immune-mediated bone marrow suppression and mitochondrial injury by forming reactive metabolites, leading to reactive oxygen species accumulation. Caffeine exerts its toxic effects by antagonizing adenosine receptors and inhibiting phosphodiesterase, resulting in central nervous system and myocardium hyperexcitability. The co-administration of both agents synergistically amplified these toxic responses, leading to metabolic acidosis, intracellular Ca2+ overload, and multiorgan dysfunction. Knowingly, this is the first forensic toxicological report of death caused by combined aminopyrine and caffeine overdose and provides the first documented quantitative measurement of lethal aminopyrine concentration in postmortem blood.

Accessory sutures of the skull are uncommon anatomical variants that mimic fractures, especially in infants with incomplete ossification. Here, we report the case of a 6-month-old female infant who died after hospitalization for cardiac arrest. Postmortem computed tomography (PMCT) revealed a transverse linear lucency in the occipital bone accompanied by intracranial hemorrhage, initially raising the suspicion of a skull fracture and non-accidental injury. However, detailed examination at autopsy confirmed that the lucency represented an accessory occipital suture rather than a fracture and was unrelated to the intracranial hemorrhage. This case highlights that accurate interpretation of PMCT and autopsy findings requires knowledge of normal anatomical variants, especially in infant death investigations. Awareness of accessory sutures and the application of advanced computed tomography techniques, such as three-dimensional reconstruction, combined with histological confirmation, if necessary, are crucial to avoid diagnostic errors and unjust suspicion of child abuse.

In forensic medicine, age estimation commonly involves assessing age-related changes in teeth and skeletal structures. Vertebral morphological alterations, such as osteophyte formation, serve as age indicators. Recent studies using deep-learning techniques, such as neural networks, for age estimation from radiographic images have been conducted, reporting significantly higher accuracy than previous studies. This study aimed to estimate age using neural network-based deep-learning techniques applied to computed tomography (CT) cross-sectional images of the spine and evaluate its feasibility. Postmortem CT scans of 214 cadavers with varying decomposition levels were used. Coronal and sagittal cross-sectional images penetrating the center of each vertebral body were extracted for the 11th and 12th thoracic vertebrae and the first to fifth lumbar vertebrae. Using these images, along with the chronological ages of deceased individuals, an age estimation model was developed through regression analysis in PyTorch, employing a convolutional neural networks architecture with five-fold cross-validation. The model achieved a mean absolute error of 5.385 years, root mean squared error of 7.029 years, and coefficient of determination of 0.793. Although the sample size was relatively small, the results suggested the potential applicability of vertebral imagingbased age estimation in the Korean population. Further research using a larger dataset may improve the accuracy and reliability of the model.

Fatal hemorrhage from vascular access is a rare but life-threatening complication in patients undergoing hemodialysis. Determining the cause and manner of unwitnessed death is challenging, highlighting the importance of forensic evaluation. A 62-year-old woman undergoing long-term hemodialysis was found dead in her bathroom. Scene investigation revealed extensive bright-red blood loss and multiple bloodstain patterns. External examination revealed a 5 cm oval-shaped bulging lesion at the arteriovenous fistula site on the left upper arm, consistent with a pseudoaneurysm. The overlying skin was thinned with whitish discoloration, and two focal dark reddish lesions at the center, one with a ruptured defect. No other significant injuries were found. Death was attributed to massive hemorrhage from arteriovenous fistula rupture. Based on scene findings and external examination, homicide and suicide were excluded; necrotic changes indicated progressive deterioration, confirming spontaneous rupture. This case demonstrates that pseudoaneurysm formation and skin changes in arteriovenous fistulas may lead to fatal hemorrhage. Careful evaluation of morphological features and scene findings is essential for determining the cause and manner of death in unwitnessed cases.

Acute peritonitis is a life-threatening condition that, if left untreated, can rapidly progress to death owing to intra-abdominal sepsis. Here, we report an autopsy case of a 46-year-old Uzbek man who had experienced abdominal pain for about a month but died without timely medical intervention due to barriers to accessing care associated with his undocumented status. Autopsy revealed more than 1,600 mL of purulent ascites in the peritoneal cavity and localized purulent collection in the omentum. Culture of ascitic fluid collected at autopsy yielded bacterial growth, and subsequent 16S rRNA gene sequencing identified Klebsiella variicola, an emerging pathogen frequently misidentified as K. pneumoniae and associated with higher mortality in bloodstream infections, together with Phytobacter massiliensis (formerly Metakosakonia massiliensis), a recently reclassified taxon rarely reported as a cause of human intra-abdominal infection. This case highlights the forensic value of molecular diagnostics for accurate pathogen identification in postmortem investigations, with social barriers contributing to delayed presentation, which allows the infection to progress to a fatal outcome.

Infectious disease constitutes on one of the main causes of death that is identified on forensic autopsies. However, the postmortem diagnosis of these diseases and the assessment of their severity constitute major challenges. Procalcitonin (PCT), which is used as a biomarker for sepsis in clinical settings, has been applied in the context of forensic autopsies. In this study, we aimed to evaluate the utility of PCT testing in the postmortem diagnosis of infectious disease. This retrospective analysis included cases wherein autopsies with PCT testing were performed at the National Forensic Service between November 2023 and December 2024. Relevant data were collected through a comprehensive review of autopsy reports. Although the PCT concentrations in the infectious disease group were significantly higher than those in the control group, clinical sepsis criteria showed limited sensitivity in the postmortem diagnosis of infectious diseases. The comparison of clinical medical records and postmortem laboratory results revealed that PCT concentrations decreased after death. Thus, despite the usefulness of PCT testing for the postmortem diagnosis and determination of death from infectious diseases, the results should be interpreted comprehensively in conjunction with other autopsy findings rather than being used as a standalone criterion.