Fatal Injuries Caused by Falling Trees: Correlation Between Postmortem Computed Tomography and Forensic Autopsy Findings in Eight Cases.

Falling trees and large branches can result in severe blunt trauma; however, detailed correlations between postmortem computed tomography (PMCT) and forensic autopsy findings in such deaths remain limited. We retrospectively analysed eight consecutive deaths occurring between 2012 and 2025 in which impact or compression by a tree trunk or large branch constituted the primary traumatic event and in which both PMCT and complete forensic autopsy were performed. Thin-slice PMCT of the head and trunk was obtained using standard brain, soft-tissue, lung, and bone windows, supplemented by a gas-optimised thoracic setting. Scene information, PMCT, and autopsy findings were integrated to determine the primary mechanism of death and to compare intracranial, thoracoabdominal, skeletal, and asphyxial injuries. Four lethal mechanisms were identified: instantly fatal head or brainstem injury (n = 2), haemorrhagic shock without cardiac rupture (n = 2), traumatic shock with cardiac rupture and/or aortic injury (n = 2), and asphyxia due to smothering or thoracic compression (n = 2). PMCT demonstrated complex fractures of the ribs, scapulae, spine, and pelvis, as well as haemothorax, haemoperitoneum, pneumomediastinum, and pre-existing coronary artery calcification, and suggested aortic injury in one case. However, brainstem lesions, precise sites of cardiac and aortic rupture, and low-contrast parenchymal injuries were identified only at autopsy. These results suggest that PMCT is valuable for delineating global injury patterns and high-energy marker lesions in falling-tree deaths, whereas full forensic autopsy remains essential for establishing the exact mechanism of death.