Use of postmortem computed tomography to reveal acute subdural hematoma in a severely decomposed body with advanced skeletonization.

An 81-year-old man was found dead 1 month after he had disappeared following a visit to a hot spring resort in early autumn. The body showed severe postmortem changes with advanced skeletonization from the head to the abdomen as well as putrefactive and autolytic changes in the remaining tissues. The thoracic and abdominal organs had been lost. Naked eye examination revealed soft tissue injuries accompanied by ragged edges and characteristic punctures with no signs of vitality, suggesting that these injuries had been due to postmortem animal scavenging. However, bruises were prominent on the anterior parts of both lower extremities. Postmortem computed tomography (PMCT) scan demonstrated subdural hematoma over the right cerebral hemisphere, although the brain itself had undergone putrefactive and autolytic changes. Subsequent autopsy confirmed the presence of a 140 g acute subdural hematoma, which would likely have been fatal. This case illustrates that PMCT is able to yield important information about possible cause of death, even in a partially skeletonized body.