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.

When death occurs, the supply of adenosine triphosphate through respiration ceases, and rigor mortis begins approximately 20 minutes after death. The underlying mechanisms of rigor mortis and cadaveric spasm are assumed to be similar. However, unlike rigor mortis, cadaveric spasm is a very rare phenomenon in which muscle stiffness develops almost immediately after death. Herein we describe a 27-year-old male with suspected cadaveric spasm. A forensic pathologist concluded that the cause of death was a head injury due to a fall. When the body was discovered, a cigarette remained in the mouth, suggesting a cadaveric spasm. Some opinions deny the existence of cadaveric spasm because there is no precise pathophysiological mechanism to support it. Cadaveric spasm could not be confirmed in the present case; however, while the complete mechanism is unclear, as in this case, it is sometimes difficult to rule out the presence of cadaveric spasm in forensic investigations. Therefore, a comprehensive forensic examination is necessary, and forensic examiners should be cautious.

Postmortem computed tomography (PMCT) is used in forensic medicine worldwide due to its ability to non-invasively visualize injuries, hemorrhage, and estimate volume. In the autopsy of infants, assessing nutritional conditions such as weight is crucial for identifying neglect. This study aims to evaluate the usefulness of retrospectively estimating the weight of Korean infants using PMCT-based volume and multiplication factors, even when the body has been cremated. A total of 44 cases of infant death (under 12 months) were analyzed. PMCT images were obtained before autopsy. Autopsy records and documentation provided by the police at the time of autopsy were reviewed to determine the weight (g) of the infant. PMCT-based infant volumes (mL) were estimated using a three-dimensional semi-automatic segmentation method. Multiplication factors (g/mL) were calculated by dividing the weight recorded at autopsy by the PMCT-based volume, yielding a mean of 1.047 g/mL, ranging from 1.014 g/mL to 1.085 g/mL. The mean absolute error compared to weights recorded at autopsy was 95 g. Significant discrepancies were observed between weights recorded at the scene or medical center and those measured at autopsy. This study demonstrates that PMCT-based weight estimation for Korean infants is a reliable method and has the potential for retrospectively validating incorrect weight measurements and addressing inconsistencies in recorded weight data.

Methyl salicylate is widely used in various topical products, including sports creams, ointments, patches, and oral hygiene products. These products are mainly used for localized treatment of musculoskeletal pain. Given their intended topical application, their ingestion can result in salicylic acid poisoning due to their high concentrations of methyl salicylate. Symptoms of salicylic acid poisoning may include dizziness, vomiting, hallucinations, seizures, and, in severe cases, unconsciousness, respiratory failure, and circulatory disorders. We report a case of a 71-year-old male who ingested Mensolatum Lotion to commit suicide and died.

The aim of this study was to elucidate the diatomological investigation and the forensic role of spleen tissue in cases of drowning or non-drowning. Specimens of spleen tissue and other organ tissue from 136 drowning cases, as well as 21 cases where death resulted from causes other than drowning (acting as controls), were examined for the presence of diatoms. The diatom test was performed on all cases using the acid digestion method, involving fumed nitric acid on a hot sand bath. The presence of diatoms in spleen tissue was observed in drowning cases but not in non-drowning cases. Diatoms in spleen tissue showed a positive association with drowning (P=0.011). Among the 136 drowning cases, diatoms were most frequently found in lung tissue (n=134, 99%), followed by spleen (n=33, 24%), kidney (n=28, 21%), liver (n=27, 20%), and heart (n=22, 16%) tissues. Moreover, in 95 cases where putrefaction did not progress, diatoms were detected in spleen tissues in 14 cases, indicating that the highest detection rate among other enclosed organ tissues, excluding lung tissues. Furthermore, a significant correlation was observed between the presence of diatoms in spleen tissue and those in enclosed organs, including the liver, kidney, and heart, but not in lung tissues. Our results revealed a significant correlation between the presence of diatoms in spleen tissue and drowning. Thus, the present study provides evidence that the presence of diatoms in spleen tissue may be a reliable indicator of death by drowning.

Detecting sphenoid sinus fluid (SSF) is an additional finding in autopsies for diagnosing drowning. SSF can provide additional forensic evidence through laboratory tests such as diatom and electrolyte analyses. If drowning is suspected, accurately assessing the presence and volume of SSF during an autopsy is crucial. Utilizing postmortem computed tomography (PMCT) images could aid in accurately sampling SSF. Accurately segmenting the region of interest is essential for volume analysis using computed tomography images. However, manual segmentation techniques are labor-intensive and time-consuming, and their success depends on the experience of the observer. Therefore, this study aimed to develop a U-Net–based deep learning model for the automatic segmentation of SSF in drowning cases using PMCT images and to evaluate the performance of the model. We retrospectively reviewed 34 drowning cases in which both PMCT scans and forensic autopsies were performed at our institution. The U-Net architecture of deep learning was used for automatic segmentation. The proposed model achieved the Dice similarity coefficient (DSC) and Intersection over Union (IoU) of a maximum of 95.85% and 92.03%, a minimum of 0% and 0%, and an average of 77.15% and 67.18%, respectively. Although the average DSC and IoU did not show high similarity, this study showed that PMCT images can be used for automatic segmentation of SSF in drowning cases, which could improve the performance with sufficient dataset acquisition and further model training.

Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.

Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.

The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.