Fortuitous discovery of a metallic foreign body on post-mortem CT scan: bullet or not bullet?

This is the authors' abstract. We don't add key points for this paper.

• Post-mortem CT is essential for detecting foreign bodies in decomposed or charred bodies. • Miniaturized pacemakers (TPS) can resemble ballistic projectiles, requiring careful image interpretation. • TPS devices are increasingly implanted. • The use of different kernel and 3D reconstructions using MIP in a bone kernel, on a slice passing through the longitudinal axis of the device is recommended in post-mortem CT. • With the widespread use of imaging in forensic institutes, non-radiologist forensic doctors must have simplified image processing protocols to make accurate diagnoses. In the expanding field of post-mortem imaging, post-mortem computed tomography (PMCT) has emerged as an essential tool for forensic pathologists. It is particularly valuable for detecting and accurately localizing metallic foreign bodies, thereby assisting the forensic pathologist during the autopsy. This study presents a case of an accidental finding of a foreign body during a PMCT, initially misinterpreted as a potential ballistic foreign body by the forensic pathologist who had quickly reviewed the scan prior to the autopsy, due to its metallic appearance and the victim’s history of involvement in armed conflicts. The forensic pathologist, unaware of a miniaturized pacemaker, specifically a Transcatheter Pacing System (TPS), initially suspected a cardiac bullet but ruled this out upon autopsy, as there were no signs of trauma or cutaneous entry wounds and the discovery of the TPS. Advanced processing techniques allowed the identification of the characteristic anchoring tines of the TPS, confirming its nature and distinguishing it from a bullet. This highlights the importance of precise post-mortem images’ interpretation.