Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident

  • Jakob HeimerEmail author
  • Dominic Gascho
  • Carlo Tappero
  • Michael J. Thali
  • Niklaus Zoelch
Case Report


In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and 1H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ 1H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer’s acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.


Postmortem computed tomography Postmortem magnetic resonance imaging Postmortem magnetic resonance spectroscopy Biofluids Intravenous fluids 



Computed tomography


Magnetic resonance imaging


Proton magnetic resonance spectroscopy


Nuclear magnetic resonance


Echo time


Repetition time


Parts per million


Trimethylammonium-containing compounds (cholines + carnitine)


Methyl group of creatine


Extramyocellular lipids


Intramyocellular lipids


Hydroxyethyl starch



The authors express their gratitude to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

Compliance with ethical standards

This article does not contain any studies with (living) human participants or animals performed by any of the authors. No informed consent was required. Ethical approval was obtained by the Ethics Committee of the Canton of Zurich, Nr. KEK ZH-Nr. 15–0686 and 18–0758.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Forensic Medicine, Department of Forensic Medicine and ImagingUniversity of ZurichZurichSwitzerland
  2. 2.Department of RadiologyHôpital FribourgeoisFribourgSwitzerland
  3. 3.Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity of ZurichZurichSwitzerland

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