Postmortem computed tomography findings in homicide victims stratified by injury mechanism: a retrospective descriptive case series correlated with conventional autopsy.

PURPOSE: To evaluate the diagnostic utility and inherent limitations of postmortem computed tomography (PMCT) in homicide investigations by correlating imaging findings with conventional autopsy results across diverse injury mechanisms. MATERIALS AND METHODS: This retrospective study analyzed 44 homicide victims who underwent pre-autopsy PMCT and subsequent forensic autopsy. Imaging findings were systematically compared with autopsy (the reference standard). Lesions were categorized as PMCT-detectable or PMCT-occult, stratified by injury mechanism: sharp force (n = 13), blunt force (n = 11), asphyxiation (n = 14), and others (n = 6). RESULTS: PMCT demonstrated high utility for identifying gross structural damage in sharp and blunt force homicides, successfully detecting hemopneumothorax, hemopericardium, and major fractures. Conversely, PMCT was inherently limited in evaluating precise stab wound trajectories, localized vascular injuries, and superficial soft-tissue trauma. In asphyxiation cases, PMCT was predominantly non-diagnostic for functional causes, although it successfully identified laryngohyoid complex fractures in strangulation cases where such fractures were present. Overall, PMCT provided actionable preliminary evidence but could not reliably determine pathophysiological causes without clinical context. CONCLUSION: PMCT serves as a critical adjunct in homicide investigations, highly adept at delineating structural and skeletal trauma. However, its limitations in soft-tissue evaluation and functional diagnosis underscore the absolute necessity of conventional autopsy. Recognizing these modality-specific diagnostic pitfalls is essential for accurate forensic imaging interpretation in medico-legal practice.