[Strangulation].

Clinical problem: Detection of manual strangulation, choking and hanging, as well as the intensity of these actions, helps to clarify the course of events, to enforce the state's right to prosecute and ultimately to protect against further attacks. However, this is complicated by the scarcity of externally visible findings.

Standard procedure to date: The forensic examination of the head and neck after strangulation is carried out by means of external inspection to detect injuries and congestion above the strangulation level. Lesions below the surface of the skin, in particular of the subcutaneous fat tissue, the muscles or the laryngeal structures, usually escape the external inspection.

Forensic radiology as an important component: Imaging techniques allow internal injuries to be recorded and objectified, which can be of considerable added value in the collection of evidence. Since criminal proceedings must meet the highest standards of security, high demands are placed on imaging and diagnosis.

Assessment: Imaging techniques are suitable for detecting and objectifying internal injuries after a person has survived strangulation. However, their excellent reconstruction and visualization capabilities also make them a valuable addition to postmortem examinations.

Recommendations for practice: After reported and survived strangulation, choking or hanging, magnetic resonance imaging (MRI) of the soft tissues of the neck should be performed as soon as possible, and if cerebral damage is suspected, the skull should also be examined. If the event was not survived, whole-body computed tomography (CT) is now standard practice at many forensic medicine institutes.