Forensic imaging in mass disasters: results of the use of post-mortem computed tomography in earthquake victims

• Limited literature exists on mortuary operations in mass disasters. • Full autopsies may be unfeasible in mass disasters with many decedents. • PMCT confirmed and detailed skeletal trauma beyond external examination. • PMCT detected hidden visceral injuries not seen at external inspection. • PMCT enabled 3D reconstructions for court and medico-legal evidence. The use of Post-Mortem Computed Tomography (PMCT) has been proposed to investigate victims of mass fatalities. This study presents forensic investigations conducted on victims of a mass disaster. In May 2012, an earthquake occurred in the province of Modena (Italy). On that occasion, 12 workers died and were found lifeless under the rubble of the industries in which they worked. All corpses were identified at the scene of the natural accident. The Prosecutor asked the forensic pathologist to perform only an external examination to identify the cause and manner of death. The forensic pathologist obtained permission to also perform PMCT to produce additional medico-legal evidence. The Prosecutor would request a judicial autopsy if the previous investigations had proved insufficient to define the cause and manner of death. External examination revealed the presence of bone fractures, enabling localization of the injuries by anatomical region (skull, thorax, pelvis, upper extremities, lower extremities). PMCT was beneficial in identifying the exact nature and extent of skeletal injuries and direct (e.g., shattered organ) and indirect (e.g., hemoperitoneum without obvious organ laceration) evidence of organ injury. In two cases, PMCT findings were essential to perfecting the diagnosis of the cause of death. Our experience supports the view that, in cases of major natural disasters, cause and manner of death may be determined with a reasonable degree of medical certainty thanks to circumstantial elements, external examination, and PMCT findings.