Skip to main content

Advertisement

SpringerLink
Log in

Postmortem CT and autopsy findings in nine victims of terrorist attack

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

In a foreign country, a religious terrorist group raided a restaurant, using pipe bombs, sharp-edged weapons, and various types of firearms (handguns, submachine guns, and AK-47 assault rifles) loaded with normal and prohibited bullets to kill foreigner customers, some of whom were Italian tourists. Local pathologists performed forensic autopsies on the bodies, but we were asked to perform additional external examinations, postmortem computed tomography (PMCT) scans, and then a second round of complete autopsies on nine victims (5 females and 4 males). Four victims had slash wounds inflicted by sharp-edged weapons, mostly localized in the head and neck. All but two victims had gunshot wounds. Finally, three casualties had injuries caused by the explosion of improvised explosive devices. In all cases, PMCT was a reliable source of information and provided strategic guide during autopsies, helping identify and describe the injuries and thus reconstruct the events. Therefore, in these cases, we suggest integrating the autopsy findings with the postmortem radiological data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. Tessler RA, Mooney SJ, Witt CE, O'Connell K, Jenness J, Vavilala MS, Rivara FP (2017) Use of firearms in terrorist attacks: differences between the United States, Canada, Europe, Australia, and New Zealand. JAMA Intern Med 177:1865–1868. https://doi.org/10.1001/jamainternmed.2017.5723

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gibbons AJ, Farrier JN, Key SJ (2003) The pipe bomb: a modern terrorist weapon. J R Army Med Corps 149(1):23–26

    Article  CAS  Google Scholar 

  3. Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, Sodickson AD, Lev MH (2016) Blast injuries: from improvised explosive device blasts to the Boston Marathon bombing. Radiographics 36(1):295–307. https://doi.org/10.1148/rg.2016150114.Review.Matthews

    Article  PubMed  Google Scholar 

  4. DePalma RG, Burris DG, Champion HR, Hodgson MJ (2005) Blast injuries. N Engl J Med 352(13):1335–1342

    Article  CAS  Google Scholar 

  5. Alvis-Miranda HR, Rubiano AM, Agrawal A, Rojas A, Moscote-Salazar LR, Satyarthee GD, Calderon-Miranda WG, Hernandez NE, Zabaleta-Churio N (2016) Craniocerebral gunshot injuries; a review of the current literature. Bull Emerg Trauma 4:65–74

    PubMed  PubMed Central  Google Scholar 

  6. Jorgensen JJ, Naess PA, Gaarder C (2016) Injuries caused by fragmenting rifle ammunition. Injury 47:1951–1954. https://doi.org/10.1016/j.injury.2016.03.023

    Article  PubMed  Google Scholar 

  7. Prinz M, Carracedo A, Mayr WR, Morling N, Parsons TJ, Sajantila A, Scheithauer R, Schmitter H, Schneider PM (2007) International Society for Forensic Genetics. DNA Commission of the International Society for Forensic Genetics (ISFG): recommendations regarding the role of forensic genetics for disaster victim identification (DVI). Forensic Sci Int Genet (1):3-12. https://doi.org/10.1016/j.fsigen.2006.10.003

  8. Ampanozi G, Halbheer D, Ebert LC, Thali MJ, Held U (2020) Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med 134(1):321–337. https://doi.org/10.1007/s00414-019-02140-y

    Article  PubMed  Google Scholar 

  9. Gascho D, Thali MJ, Niemann T (2018) Post-mortem computed tomography: technical principles and recommended parameter settings for high-resolution imaging. Med Sci Law 58(1):70–82. https://doi.org/10.1177/0025802417747167

    Article  PubMed  Google Scholar 

  10. Bolliger SA, Thali MJ (2015) Imaging and virtual autopsy: looking back and forward. Philos Trans R Soc Lond Ser B Biol Sci 370(1674):20140253. https://doi.org/10.1098/rstb.2014.0253

    Article  Google Scholar 

  11. Ruder TD, Flach PM, Thali MJ (2013) Virtual autopsy. Forensic Sci Med Pathol 9(3):435–436. https://doi.org/10.1007/s12024-013-9454-2

    Article  PubMed  Google Scholar 

  12. Grassi S, Campuzano O, Coll M, Brión M, Arena V, Iglesias A, Carracedo Á, Brugada R, Oliva A (2020) Genetic variants of uncertain significance: How to match scientific rigour and standard of proof in sudden cardiac death? Legal Med (Tokyo, Japan) 45:101712. Advance online publication. https://doi.org/10.1016/j.legalmed.2020.101712

  13. Aquila I, Sacco MA, Abenavoli L, Malara N, Arena V, Grassi S, Ausania F, Boccuto L, Ricci C, Gratteri S, Oliva A, Ricci P (2020) SARS-CoV-2 pandemic: review of the literature and proposal for safe autopsy practice. Arch Pathol Lab Med. https://doi.org/10.5858/arpa.2020-0165-SA

  14. Madea B (2014) Kraniales CT als Grundlage von Tatrekonstruktion und Identifzierung eines Tatwerkzeuges [Cranial CT as basis for reconstruction of events and identification of a weapon]. Arch Kriminol 234(1-2):59–65 German

    PubMed  Google Scholar 

  15. Schyma C, Hagemeier L, Greschus S, Schild H, Madea B (2012) Visualisation of the temporary cavity by computed tomography using contrast material. Int J Legal Med 126(1):37–42. https://doi.org/10.1007/s00414-010-0546-1

    Article  PubMed  Google Scholar 

  16. Craigie RJ, Farrelly PJ, Santos R, Smith SR, Pollard JS, Jones DJ (2020) Manchester Arena bombing: lessons learnt from a mass casualty incident. BMJ Mil Health 166:72–75

    Article  Google Scholar 

  17. Visentin S, Pelletti G, Dengo C, De Matteis M, Montisci M (2017) Post-autopsy computed tomography. Pros and cons in a firearm death. Forensic Sci Int. https://doi.org/10.1016/j.forsciint.2017.04.017

  18. Quatrehomme GToupenay S, Delabarde T, Padovani B, Alunni V (2019) Forensic answers to the 14th of July 2016 terrorist attack in Nice. Int J Legal Med 133(1):277–287. https://doi.org/10.1007/s00414-018-1833-5

    Article  Google Scholar 

  19. Tartaglione T, Filograna L, Roiati S, Guglielmi G, Colosimo C, Bonomo L (2012) Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds. Radiol Med 117(3):461–470. https://doi.org/10.1007/s11547-011-0784-4

    Article  CAS  PubMed  Google Scholar 

  20. Cascini F, Polacco M, Cittadini F, Paliani GB, Oliva A, Rossi R (2020) Post-mortem computed tomography for forensic applications: a systematic review of gunshot deaths. Med Sci Law 60(1):54–62. https://doi.org/10.1177/0025802419883164

    Article  PubMed  Google Scholar 

  21. Filograna L, Tartaglione T, Filograna E, Cittadini F, Oliva A, Pascali VL (2010) Computed tomography (CT) virtual autopsy and classical autopsy discrepancies: radiologist’s error or a demonstration of post-mortem multi-detector computed tomography (MDCT) limitation. Forensic Sci Int 195(1-3):e13–e17. https://doi.org/10.1016/j.forsciint.2009.11.001

    Article  PubMed  Google Scholar 

  22. Chattopadhyay CS, Sukul B (2013) Pattern of defence injuries among homicidal victims. Egypt J Forensic Sci 3: 81–84

  23. Handlos P, Uvíra M, Dokoupil M, Marecová K (2019) Axe injury pattern in homicide. Forensic Sci Med Pathol Sep 15(3):516–518. https://doi.org/10.1007/s12024-019-00112-7

    Article  Google Scholar 

  24. Penn-Barwell JG, Brown KV, Fries CA (2015) High velocity gunshot injuries to the extremities: management on and off the battlefield. Curr Rev Musculoskelet Med 8:312–317. https://doi.org/10.1007/s12178-015-9289-4

    Article  PubMed  PubMed Central  Google Scholar 

  25. Khorram-Manesh A (2016) Europe on fire; medical management of terror attacks - new era and new considerations. Bull Emerg Trauma 4:183–185

    PubMed  PubMed Central  Google Scholar 

  26. Maiden N (2009) Ballistics reviews: mechanisms of bullet wound trauma. Forensic Sci Med Pathol 5:204–209. https://doi.org/10.1007/s12024-009-9096-6

    Article  PubMed  Google Scholar 

  27. Swift B, Rutty GN (2004) The exploding bullet. J Clin Pathol 57(1):108

    Article  CAS  Google Scholar 

  28. Hakki L, Smith A, Babin J, Hunt J, Duchesne J, Greiffenstein P (2019) Effects of a fragmenting handgun bullet: considerations for trauma care providers. Injury 50(5):1143–1146. https://doi.org/10.1016/j.injury.2019.01.033

    Article  PubMed  Google Scholar 

  29. Kirchhoff SM, Scaparra EF, Grimm J, Scherr M, Graw M, Reiser MF, Peschel O (2016) Postmortem computed tomography (PMCT) and autopsy in deadly gunshot wounds--a comparative study. Int J Legal Med 130:819–826. https://doi.org/10.1007/s00414-015-1225-z

    Article  CAS  PubMed  Google Scholar 

  30. Levy AD, Abbott RM, Mallak CT, Getz JM, Harcke HT, Champion HR, Pearse LA (2006) Virtual autopsy: preliminary experience in high-velocity gunshot wound victims. Radiology 240:522–528. https://doi.org/10.1148/radiol.2402050972

    Article  PubMed  Google Scholar 

  31. Makhlouf F, Scolan V, Ferretti G, Stahl C, Paysant F (2013) Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-months retrospective study. Leg Med (Tokyo) 15:145–148. https://doi.org/10.1016/j.legalmed.2012.11.002

    Article  CAS  Google Scholar 

  32. Mahoney PF, Carr DJ, Delaney RJ, Hunt N, Harrison S, Breeze J, Gibb I (2017) Does preliminary optimisation of an anatomically correct skull-brain model using simple simulants produce clinically realistic ballistic injury fracture patterns? Int J Legal Med Jul 131(4):1043–1053. https://doi.org/10.1007/s00414-017-1557-y

    Article  CAS  Google Scholar 

  33. Monica Coll, Catarina Allegue, Sara Partemi, Jesus Mates, Bernat Del Olmo, Oscar Campuzano, Vincenzo Pascali, Anna Iglesias, Pasquale Striano, Antonio Oliva, Ramon Brugada, (2016) Genetic investigation of sudden unexpected death in epilepsy cohort by panel target resequencing. International Journal of Legal Medicine 130 (2):331-339. https://doi.org/10.1007/s00414-015-1269-0

  34. Sara Partemi, Monica Coll Vidal, Pasquale Striano, Oscar Campuzano, Catarina Allegue, Marianna Pezzella, Maurizio Elia, Pasquale Parisi, Vincenzo Belcastro, Susanna Casellato, Lucio Giordano, Massimo Mastrangelo, Nicola Pietrafusa, Salvatore Striano, Federico Zara, Amedeo Bianchi, Daniela Buti, Angela La Neve, Carlo Alberto Tassinari, Antonio Oliva, Ramon Brugada, (2015) Genetic and forensic implications in epilepsy and cardiac arrhythmias: a case series. International Journal of Legal Medicine 129 (3):495-504. https://doi.org/10.1007/s00414-014-1063-4

Download references

Acknowledgments

We thank all the other members of the team that worked on these cases (in alphabetical order): Laura Baldassarri, Ilaria Boschi, Andrea Cambieri, Valentino De Matteis, Alessandro di Luca, Gerardo Di Masi, Francesca Filloramo, Federica Foti, Carolina Giannace, Domenico Laino, Gianluca Lentini, Maria Alessandra Marrucci, Eleonora Ricci, Davide Rinelli, Francesca Scarnicci, Giuseppe Vetrugno, and Tommaso Tartaglione.

Funding

This work has been supported by Fondi di Ateneo, Università Cattolica del Sacro Cuore, Linea D1 (Recipient: Antonio Oliva).

Author information

Author notes

  1. Laura Filograna and Vincenzo L. Pascali should be considered co-senior authors

Authors and Affiliations

  1. Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy

    Antonio Oliva, Simone Grassi, Vincenzo M. Grassi & Vincenzo L. Pascali

  2. Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy

    Vilma Pinchi

  3. Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, “Tor Vergata”, Rome, Italy

    Roberto Floris, Guglielmo Manenti & Laura Filograna

  4. Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Cesare Colosimo

Authors
  1. Antonio Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo M. Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vilma Pinchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Floris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guglielmo Manenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cesare Colosimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laura Filograna
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vincenzo L. Pascali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Oliva.

Ethics declarations

Conflicts of interest/Competing interests

The authors declare that they have no conflict of interest.

Consent to participate

Not required.

Ethics approval

Not required since the data is completely anonymous with no personal information being collected.

Consent for publication

These cases have been dismissed by the local Court, and consent for publication has been provided by the public prosecutor.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Antonio Oliva and Simone Grassi should be considered co-first authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliva, A., Grassi, S., Grassi, V.M. et al. Postmortem CT and autopsy findings in nine victims of terrorist attack. Int J Legal Med 135, 605–618 (2021). https://doi.org/10.1007/s00414-020-02492-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-020-02492-w

Keywords

Search

Navigation