Pathology has benefited from the rapid progress of image-digitizing technology during the last decade. However, the application of digital whole slide images (WSI) in forensic pathology still needs to be improved. WSI validation is crucial to ensure diagnostic performance, at least equivalent to glass slides and light microscopy. The College of American Pathologists Pathology and Laboratory Quality Center recently updated internal digital pathology system validation recommendations. Following these guidelines, this pilot study aimed to validate the performance of a digital approach for forensic histopathological diagnosis. Six independent skilled forensic pathologists from different forensic medicine institutes evaluated 100 glass slides of forensic interest (80 stained with standard hematoxylin and eosin, 20 with special staining), including different organs and tissues, with light microscopy (Olympus BX51, Tokyo, Japan). Glass slides were scanned using the Aperio GT 450 DX Digital Slides Scanner (Leica Biosystems, Nussloch, Germany). After two wash-out weeks, forensic pathologists evaluated WSIs in front of a widescreen using computer devices with dedicated software (O3 viewer, O3 Enterprise, Zucchetti, Trieste, Italy). Side-by-side comparisons between diagnoses performed on tissue glass slides versus WSIs were above the threshold stated in the validation guidelines (mean concordance of 97.8%). CSUQ Version 3 questionnaire showed high satisfaction for all pathologists (mean result: 6.6/7). Our institutional digital forensic pathology system has been validated for practical casework application. This approach opens new scenarios in practical forensic casework investigations, such as sharing live histological ex-glass slides online, as well as educational and research perspectives, with improving impacts on the whole daily workflow.

Ethanol is the psychoactive substance identified most frequently in post‐mortem specimens. Unfortunately, interpreting post‐mortem ethanol concentrations can be difficult because of post‐mortem alcohol redistribution and the possibility of post‐mortem alcohol neogenesis. Indeed, in the time interval between death and sample collection, the decedent may be exposed to non‐controlled environments for an extended period, promoting microbial colonization. Many authors report that in the presence of carbohydrates and other biomolecules, various species of bacteria, yeast, and fungi can synthesize ethanol and other volatile substances in vitro and in vivo. The aim of this study was to study the impact of several variables on microbial ethanol production as well as develop a mathematical model that could estimate the microbial‐produced ethanol in correlation with the most significant consensual produced higher alcohol, 1‐propanol. An experimental setup was developed using human blood samples and cadaveric fragments incubated under strictly anaerobic conditions to produce a novel substrate, “cadaveric putrefactive blood” mimicking post‐mortem corpse conditions. The samples were analyzed daily for ethanol and 1‐propanol using an HS‐GC‐FID validated method. The formation of ethanol was evaluated considering different parameters such as putrefactive stage, blood glucose concentration, storage temperature, and storage time. Statistical analysis was performed using the Mann–Whitney non‐parametric test and simple linear regression. The results indicate that the early putrefactive stage, high blood glucose concentration, high temperature, and time of incubation increase microbial ethanol production. In addition, the developed mathematical equation confirms the feasibility of using 1‐propanol as a marker of post‐mortem ethanol production.

Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.