“Blind spots” in forensic autopsy: Improved detection of retrobulbar hemorrhage and orbital lesions by postmortem computed tomography (PMCT)

[Display omitted] •PMCT showed a high sensitivity in detection of orbital roof and basilar skull fractures.•Retrobulbar hemorrhages correlate positively to the presence of Battle’s sign.•Retrobulbar hemorrhages volume is larger in deaths with a postmortem interval exceeding 48h.•Present bulbar lesions and RBH show a statistical significant correlation. The purpose of this study was to correlate the occurrence of retrobulbar hemorrhage (RBH) with mechanism of injury, external signs and autopsy findings to postmortem computed tomography (PMCT). Six-teen subjects presented with RBH and underwent PMCT, external inspection and conventional autopsy. External inspection was evaluated for findings of the bulbs, black eye, raccoon eyes and Battle’s sign. Fractures of the viscerocranium, orbital lesions and RBH were evaluated by PMCT. Autopsy and PMCT was evaluated for orbital roof and basilar skull fracture. The leading manner of death was accident with central regulatory failure in cases of RBH (31.25%). Imaging showed a high sensitivity in detection of orbital roof and basilar skull fractures (100%), but was less specific compared to autopsy. Volume of RBH (0.1–2.4ml) correlated positively to the presence of Battle’s sign (p