Although age estimation upon death is important in the identification of unknown cadavers for forensic scientists, to the best of our knowledge, no study has examined the utility of deep neural network (DNN) models for age estimation among cadavers. We performed a postmortem computed tomography (CT) examination of 1000 and 500 male and female cadavers, respectively. These CT slices were converted into 3-dimensional images, and only the thoracolumbar region was extracted. Eighty percent of them were categorized as training datasets and the others as test datasets for both sexes. We fine-tuned the ResNet152 models using the training datasets. We conducted 4-fold cross-validation, and the mean absolute error (MAE) of the test datasets was calculated using the ensemble learning of four ResNet152 models. Consequently, the MAE of the male and female models was 7.25 and 7.16, respectively. Our study shows that DNN models can be useful tools in the field of forensic medicine.

A woman in her seventies living alone was found dead on the floor of her living room. A blue-green swelling was found from her right cheek to her anterior neck and an autopsy was performed. The autopsy revealed subcutaneous abscesses from the right cheek to the anterior neck, posterior pharyngeal abscesses, mediastinal abscesses, pleuritis, and pericarditis. The cause of death was diagnosed as sepsis due to a retropharyngeal abscess caused by extensive severe periodontitis. The presence of a dentist at the autopsy allowed for a rapid diagnosis of periodontal disease, which was the cause of the posterior pharyngeal abscesses and septic shock. Therefore, the participation of a dentist in a forensic autopsy is important not only for personal identification but also for the rapid diagnosis of the cause of death.

Ketoacidosis is one of the common diseases that sometimes result in death. In forensic autopsy cases, the measuring of ketone bodies, especially β-hydroxybutyrate (BHB), is useful in diagnosing postmortem ketoacidosis as a cause of death. However, increased BHB values are not always indicative of ketoacidosis. Other causes of death, such as hypothermia, are known to increase BHB values. In addition, sometimes, we experience cases of increased BHB values that are unlikely to be associated with the pathophysiology or the cause of death resulting in an increase in BHB values. In this study, autopsies were performed to determine the relationship between blood BHB values and the postmortem interval (PMI). The patients were divided into four groups: PMI ≤ 24 h, PMI ≤ 48 h, PMI ≤ 72 h, and PMI > 72 h. The BHB values for each group were then compared. Based on the analysis, patients with a PMI ≤ 72 h and those with a PMI > 72 h had significantly higher BHB values than patients with a PMI ≤ 24 h. In conclusion, there remains a possibility that the BHB values increase after death. Forensic pathologists should consider PMI when diagnosing ketoacidosis as the cause of death.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that may be precipitated by infection. We report the forensic autopsy of a 32-year-old woman with previously undiagnosed and reportedly untreated DM who was found dead at home after approximately 10 days of decreased appetite and 7 days of inability to eat solid food, without seeking medical care. She had a history of recurrent lateral neck swelling and discharge since early adulthood. At autopsy, a subcutaneous cystic lesion with a cutaneous draining opening was present in the left lateral neck. Histopathologically, the lesion showed extensive suppurative inflammation, keratinous debris without an identifiable epithelial lining, and adjacent lymphoid tissue; the kidneys showed pyelonephritis with microabscesses. Postmortem biochemistry showed hemoglobin A1c 15.7%, cardiac blood glucose 1308 mg/dL, femoral serum beta-hydroxybutyrate 7440 μmol/L (7.44 mmol/L), and femoral serum acetone 0.543 mg/mL; ethanol and other drugs were not detected. Methicillin-susceptible Staphylococcus aureus (MSSA) was isolated from cardiac blood, cerebrospinal fluid, and the lesion contents. DKA was considered the cause of death. Systemic MSSA infection originating from the cervical lesion, with suspected but unproven sepsis, was considered the most likely precipitating factor, with possible contributions from pyelonephritis, reduced oral intake, and dehydration. The lesion was most likely an infected branchial cleft anomaly, although an infected epidermoid cyst could not be excluded. This case shows how investigative information and postmortem examinations can be integrated to reconstruct the most likely sequence leading to death while distinguishing demonstrated findings from inferred causal relationships.