Penetrating thoracic trauma with hemopericardium and cardiac tamponade

Case contributed by Dr Francesco Macri


Man killed with a knife in prison.

Patient Data

Age: 20 years
Gender: Male

Post-mortem CT (PMCT) - Chest


The volume rendering images depict with a high grade of similarity the features of the victim's face (not shown) and the cutaneous stab wound. Interruption of the cutaneous surface of the chest and underlying hemo-pneumopericardium consistent with a pericardio-cardiac wound. Vast areas of ground glass in both lungs, liquid tracheal obstruction and bilateral pleural effusion are suggestive of massive pulmonary edema following the fast cardiac tamponade and cardiac arrest. 

Case Discussion

3D reconstructions of a post mortem CT (PMCT) study may be used instead of normal pictures to present the victim to the next of kin in a less violent way, during the trial. In this case, the victim was stabbed once in the chest and died in a few seconds. The signs of cardiac tamponade eliciting massive pulmonary edema are all present. In particular, for the pericardial tamponade, the PMCT plays a significant role before the autopsy. The forensic pathologist, when dissecting the cadaver, runs the risk of normalizing the pressure in the pericardial space. If it happens, all the signs of the pericardial tamponade are lost.  

Tracheal engorgement associated with severe pulmonary edema is suggestive of terrible agony. The massive edema has evidently induced an "air hunger" to the victim, who became hyperpneic and started to suck more and more fluid from his lungs to the trachea. This vicious circle has increased the extremely bad sensation of breathlessness till the death.

Curiosity for the reader: the defense of the murder was based on his admission of guilt targeting a punishment for involuntary manslaughter. The murderer declared that he never had the intention to kill and maintained to introduce only the tip of the blade for a maximum of 2 cm in order to scare the victim. PMCT images showed that the virtual path of the blade was deeper whereas the forensic pathologists were not able to provide this evidence to the court in a visually clear way. Eventually, the murderer was convicted of intentional homicide, which entails a more severe punishment for countries that adopt the Jus law code. 

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