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Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident

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Abstract

In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and 1H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ 1H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer’s acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

1H-MRS:

Proton magnetic resonance spectroscopy

NMR:

Nuclear magnetic resonance

TE:

Echo time

TR:

Repetition time

PPM:

Parts per million

TMA:

Trimethylammonium-containing compounds (cholines + carnitine)

CR3:

Methyl group of creatine

EMCL:

Extramyocellular lipids

IMCL:

Intramyocellular lipids

HES:

Hydroxyethyl starch

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Acknowledgments

The authors express their gratitude to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

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Authors and Affiliations

  1. Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland

    Jakob Heimer, Dominic Gascho, Carlo Tappero, Michael J. Thali & Niklaus Zoelch

  2. Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland

    Carlo Tappero

  3. Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland

    Niklaus Zoelch

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  1. Jakob Heimer
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Correspondence to Jakob Heimer.

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This article does not contain any studies with (living) human participants or animals performed by any of the authors. No informed consent was required. Ethical approval was obtained by the Ethics Committee of the Canton of Zurich, Nr. KEK ZH-Nr. 15–0686 and 18–0758.

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Heimer, J., Gascho, D., Tappero, C. et al. Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident. Int J Legal Med 134, 1167–1174 (2020). https://doi.org/10.1007/s00414-019-02190-2

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  • DOI: https://doi.org/10.1007/s00414-019-02190-2

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