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The progress in quality and availability of imaging studies has made them an invaluable part of the clinical diagnostic process, so much so that the forensic medical community had to acknowledge their importance and to implement them in death investigations. Since 2011 roughly 200 post-mortem radiographic examinations were conducted, mostly followed by full autopsies. Four of those cases are given as an example of the benefits and limitations of these methods. A review of the literature and our experience so far, show that computed tomography provides better visualization and 3D reconstruction of traumatic bone injuries, as well as good assessment of air in the tissues and vascular system, gunshot wound tracts, and anthropological characteristics for identification. Imaging methods are relatively limited in definite diagnostic findings in cases of sudden death from natural causes, such as pneumonia, pulmonary embolism, acute myocardial infarction or meningitis, problems which can be partially solved with the aid of angiographic studies. These methods also do not allow for sampling of tissues for microscopic examination, nor fluid samples for cultures and toxicology. In the current cultural and social reality in Israel, imaging studies enable minimization of the autopsy and, in certain cases, its relinquishment serves as a compromise between the necessity of death investigation and beliefs in the wholeness of the body. In light of the advantages of imaging, no autopsy of a trauma-related death can be complete without it.

Introduction: A rare event of fatal sexual assault by the insertion of a wooden rod through the anus to the upper chest is reported. Examination of the body at the scene did not raise any suspicion of assault while the subsequent autopsy revealed findings that changed the assessment of the cause of death and the circumstances., Case History: The body of a 57 years old man with a history of psychiatric illness was found in his room. At autopsy a round wooden rod which was inserted through the anus was found in the peritoneal and pleural cavities. In addition, signs of manual pressure were detected on the neck and trunk, and on the head and extremities signs of blunt trauma were observed., Discussion: In patients affected by mental disorders it is difficult to distinguish between self-inflicted anal injuries and injuries sustained during an attack. Detection of damage to other areas of the body (such as the neck) assist in determining the nature of the assault., Summary: This case demonstrates the need for a full autopsy in every case of death under unclear circumstances, especially when a limited examination of the body can't determine the type of death (natural, accident, suicide or homicide).

Coronary arteritis is the fourth most common cause of fatal cardiac disease, after coronary atheroscLerosis, congenital anomalies and coronary dissection. Eosinophilic inflammation of the coronary arteries is extremely rare, involves the major coronaries and occurs as an isolated disease or as part of Churg-Strauss syndrome or Wegener's granulomatosis with involvement of other internal organs. A case of sudden and unexpected death of a healthy young woman is presented. Autopsy revealed eosinophilic inflammation of Left coronary artery with thrombosis of the lumen, causing a fatal cardiac failure. No other pathology was detected. We discuss the importance of performing a full autopsy, including microscopic inspection of the tissues, in order to glean the cause of death and learn about new and rare pathologies.

Introduction: Sexual abuse includes obscenity, rape and sodomy. Forensic medical examinations routinely include the genital area, anus and the body of the victims for signs of recent or old injury., Objectives: To evaluate the incidence of physical evidence in forensic sexual abuse cases and to compare the Israeli findings to data from other countries, including the USA., Methods: The study was conducted during one calendar year in Israel and included 95 children from infancy to 16 years of age, of whom 83% were females. Examination results were defined by the presence of physical injury or its absence. These findings were classified by their location in the anogenital area or other body areas and findings in the anogenital area were further classified by their likelihood to have been caused by a sexual assault. The results of the examination were related to parameters such as age and sex of the participants, length of time since the last assault, and the degree of proximity between the suspected assailant and the victim., Results: Evidence of physical abuse was found in 41 patients, in 37 (39%) of these cases physical abuse was detected in the anogenital area. In all these cases of anogenital abuse, 11 (12%) showed clear evidence of sexual assault and five of them had recent signs of injury; 80% of the recent injuries in the anogenital area were identified in patients within the first 24 hours after the assault., Conclusions: The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature. A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children.

Hypothermia is a rare cause of death in Israel, and usually occurs among risk groups such as elderly people, homeless persons, psychiatric patients and persons who function in cold environments or are unintentionally exposed to such conditions. Death due to hypothermia generally occurs in extremely cold conditions, although ambient temperatures of 15-20 degrees C can also be lethal. The phenomenon of paradoxical undressing that characterizes death due to hypothermia rather occurs in moderate ambient temperatures, and takes place when the victim is in extremis. A case of death of an elderly man, whose body was found naked in a field, is reported. His head was covered with a shirt, and blunt injuries were found on his body, raising suspicion that he was smothered, or was a victim of sexual violence. On autopsy, spot hemorrhages of the gastric mucosa, which are characteristic of hypothermia, were found, along with mild cerebral atrophy, moderate atherosclerosis of the coronary and cerebral vessels and myocardial sclerosis. The combination of autopsy findings, elimination of traumatic injuries as contributors to death and the circumstances in which the body was found, led to the diagnosis of death due to hypothermia.

Background: The cause of death in cases of sudden and unexpected death is determined by the forensic pathologist based on autopsy findings and toxicological analysis. In cases where no acute pathology or lethal injury are detected, and the circumstances surrounding the death were highly stressful or emotional, it is possible to attribute the inciting event as contributory to the death by causing cardiac dysrhythmia., Method: Ten cases of sudden death related to stressful events were examined over a period of 2 years in the National Center of Forensic Pathology, all of which lacked findings of acute disease or serious injury. All suffered from variable degrees of chronic cardiac pathology, which probably contributed to dysrhythmia and death., Discussion: Since the seventies of the previous century, forensic pathologists are entitled to determine mode of death as homicide or manslaughter, due to an acute cardiac event which cannot be diagnosed in an autopsy and which was a direct result of the circumstances prior to death. Later, these conditions were adjusted to include cases where no morphological findings were detected or when death is delayed by medical treatment. The physiological mechanisms responsible include an increase in catecholamine levels, an increase in blood pressure and platelet aggregation and a delay in cardiac and vascular recovery from stress., Conclusions: Victims of sudden death caused by emotional stress, during a criminal act, usually have a background of chronic cardiac disease and/or are more susceptible physiologically to suffer an amplified reaction to stress. Legally, their deaths are considered as homicide or manslaughter.