First Case Report of the Use of Postmortem Wide-Angle Fundus Photography in Abusive Head Trauma.

Abstract

Retinal hemorrhages commonly cooccur with abusive head trauma (AHT). While wide-field fundus photography is crucial for documenting retinal hemorrhage in living children, in fatal cases, a pathologic examination is traditionally used. This report describes the case of a 4-year-old girl who died of head trauma suspected to have been caused by physical abuse. Before the autopsy, wide-field fundus photography using scanning laser ophthalmoscopy (SLO) was performed to document retinal hemorrhages. Imaging revealed that retinal hemorrhages were predominantly located at the posterior pole and in the peripheral retina of the right eye. The autopsy confirmed cranial injuries, including acute subdural hematoma. Pathologic examination of the eyes revealed hemorrhages beneath the internal limiting membrane and within the inner to outer nuclear layers of the retina. The cause of death was determined to be head trauma leading to an acute subdural hematoma. This case confirms that wide-field fundus photography using SLO can be performed postmortem, supplementing pathologic findings. Postmortem fundus photography, particularly using SLO, has the potential to reduce the risk of artifact introduction during the preparation of traditional specimens. Additional case studies are required to further refine the use of this technique and establish its potential forensic application in the diagnosis of AHT.