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Our purpose was to determine the imaging findings in three year-old frozen mummies of sacrificial Inca children. CT, conventional radiography, and dental radiography of Inca mummies were reviewed. Different techniques, which were adjusted to the anatomic position of the bodies, were used for radiologic analyses. Working sessions were limited to 20 min because of the fragility of these mummies and to prevent thawing of the specimens. Internal organs in good condition with a natural shrinkage caused by dehydration were shown on CT scans.

Both white and gray matter were clearly observed in the brain and cerebellum. The white matter and the fatty tissue of the bodies were visibly white. This condition was possibly caused by the transformation of the fatty tissue into a waxlike substance and the deposition of calcium salts.

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The lungs were expanded in all three mummies. The ages of the three children at the time of their deaths were estimated by means of radiographs of the teeth and long bones. Bone mineralization, the muscular volume, and the thickness of the adipose panniculus indicated the good nutritional state of the three Inca children. The spleen was not visualized in any case.

Radiology helped us determine the state of the internal organs, the nutritional conditions, and the physical abnormalities of the naturally mummified children. These mummies can be considered among the best preserved mummies currently known.

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Three frozen bodies belonging to three children were found by an archaeological team led by two of the authors. These children had been sacrificed years ago in times of the Inca Empire to appease the mountain deities and to ensure the emperor's well-being. In addition, the mummies were buried with more than objects, including textiles, gold and silver statues, pottery, and feathered headdresses. The children had been buried in three pit tombs built by the Incas by enlarging natural niches in the bedrock at the summit shrine of Mount Llullaillaco, which is considered to be the highest archaeological site in the world [ 1 ].

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The mummies were individually buried 1. The funerary sites were covered with a mixture of soil and stones, which was also used to fill in the platform that was later built to cover the burials.

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The extraordinary state of preservation of the mummified bodies and the careful recording of the associated offerings during the scientific excavations have given the discovery particular importance. The discovery and subsequent research have awakened the public's imagination and aroused the interest of specialists [ 2 , 3 ]. In , only a year after the discovery of X rays, radiography was used at the Museum of Natural History in Vienna to determine the contents of an Egyptian coffin.

What appeared at first to be the mummy of a person turned out to be that of a large bird, the ibis [ 4 ]. Since then, radiologic methods have proven to be valuable tools for examining mummies, offering distinct advantages over the older methods of unwrapping followed by autopsy [ 5 — 13 ].

One of the first steps in the investigation of these frozen mummies was the use of radiologic methods to evaluate the state of preservation of the internal organs, the possible causes of death, nutritional conditions, and abnormalities. The outstanding state of preservation of the mummies offered a unique opportunity for comparative diagnosis by noninvasive and nondestructive methods such as CT and conventional radiography.

The CT and conventional radiography performed on the Llullaillaco mummies have contributed to the pioneering field of the radiology of pre-Hispanic frozen bodies.

The antecedents in this field of research in the Andes are limited. In , conventional radiography was performed on the body of an Inca child from Mount El Plomo [ 14 ].

In , an adult male mummy from Mount El Toro was subjected to radiologic studies [ 15 ].

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CT and conventional radiography were performed on the male Inca mummy recovered from Mount Aconcagua in [ 16 ] and the female Inca mummy found on Mount Ampato in [ 17 ]. However, none of these bodies showed the extraordinary state of preservation of the Llullaillaco mummies. We present the results of the radiographic studies on the three frozen Inca bodies from Mount Llullaillaco.

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The Llullaillaco mummies are currently preserved in a laboratory specially designed for this purpose at the Catholic University of Salta. Each one is placed in its own freezer, which is connected to a power generator. The temperature and humidity inside the freezers are monitored by thermometers and hygrometers. A double wrapping of sterilized surgical material serves as the first layer and acid-free cotton cloth, as an outer one.

Finally, a transparent plastic layer, carefully sealed to avoid the loss of humidity from the bodies and to protect the mummies from the surrounding environment, serves as a means of preservation. Because of the aforementioned preservation conditions of the mummies and the danger of thawing, they could only be taken out for 20 min. The techniques used were adapted to the particular anatomic position of each body and its rigid nature. Because of time constraints, multiple sections of 5 mm thick were obtained at 5-mm intervals.

This timing allowed us to complete the study in 20 min. The scanning parameters were kV, 40 mA, and 2-sec scanning time. The amperage was adjusted to that level to prevent the overheating of the X-ray tube.

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Reformatting in other projections had been considered but was not possible because of the lack of suitable software.

Radiographs and orthocclusion radiographs were obtained to observe the dental maxillofacial structures of the Llullaillaco children. Teleradiography plate holders were used, and a distance of cm from the emitting focus to the sagittal line of the skull was established. The exposure was 2. Conventional radiography was performed on a portable unit because the equipment had to be transported to the laboratory where the mummies are kept.

In this nonradiology environment, we used a table without a grid. The parameters were 35—48 kV and 30—50 mAs at a distance of 80— cm, depending on the region to be studied.

In all cases, fast rare-earth screens were used. A clear differentiation of white and gray matter in the brain and cerebellum due to the change of fat into adipocere and the deposition of calcium salts were shown by the cranial CT scans Figs. The fatty tissue of the bodies and the white matter also underwent this transformation, and they were visibly white on the CT scans [ 18 , 19 ]. View larger version K Fig. Coronal cranial CT scan shows clear differentiation between white and gray matter of cerebral hemispheres.

Note air arrows surrounding brain. Coronal CT scan shows excellent state of preservation of cerebrum, pons, and medulla oblongata. Ventricles are prominent. Axial cranial CT scan shows orbits with presence of eyes, optic nerves arrows , and orbital muscles. Another feature that was observed was the loss of volume of the soft tissue due to dehydration. Air between the skull and the cerebral hemisphere and the prominence of the ventricles were clearly visualized; both were caused by volume loss.

The pons, medulla oblongata, and the spinal cord could also be seen Fig. In the thorax, the lungs appeared expanded, with a comparatively smaller loss of volume with respect to the rest of the organs because the composition of the lungs is primarily air. A defect in the left thoracic wall of the youngest mummy was produced by a lightning strike after death Fig.

This was deduced by members of the archaeological team who observed burned skin on the left side of face and body and burned clothing. The trachea, main bronchi, lung arteries, aorta, and heart could also be seen. The thymus was visualized only in the male mummy Fig. The upper lobe of the right lung of the older female showed a triangular hypodense zone corresponding presumably to an abnormal air-trapping area Fig.

In the same mummy, a clear image of the left maxillary sinus and a mucosal enlargement of the right one could be perfectly observed Fig. Axial CT scan of thorax shows that both lungs are expanded.

Defect in left thoracic wall arrows was produced by lightning strike after death. Coronal CT scan of face and thorax shows lungs and mediastinum, in which thymus arrow is well observed. Note muscular volume and thickness of subcutaneous fat. Coronal thoracic CT scan shows that both lungs are expanded. Note triangular hypodense area arrows in upper lobe of right lung and trachea and main bronchi arrowheads.

Coronal cranial CT scan shows right maxillary sinus with mucosal thickening arrows. Most of the organs in the abdomen were in an excellent state of preservation.

The size of the liver and the kidneys was reduced, although they maintained their shape. The pancreas was easily identified, although it is the first one among the glandular organs to decay, according to forensic medicine [ 20 ]. There were feces in the intestines, but the spleen was not seen in these specimens Fig.

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Axial abdominal CT scan shows liver, pancreas arrowheads , and kidneys to be perfectly preserved. Spleen is not seen. Note feces arrow in intestines.

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The CT image of the pelvic cavity showed well-preserved primary genital organs such as the uterus in the older female and the phallus in the male child.

A thick layer of fat tissue, excellent bone mineralization, and muscular volume could also be observed Fig. The frontal and lateral cranial radiographs of the three mummies showed no fractures Fig.

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The radiographs of the body allowed us to rule out any bone disease Fig. We saw no Harris lines, which would have been an indication of periods of malnutrition or illness that interfere with normal growth and metabolism [ 21 ].

Axial CT scan of pelvis shows well-preserved phallus arrow , muscles, and fatty tissues.

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Lateral radiograph of skull shows neither fracture nor deformation. Lateral radiograph of skull reveals frontal—parietal and occipital—parietal flattening, intentional cranial deformations arrows. Lateral radiograph of spinal column shows that thoracic and lumbar vertebrae have excellent mineralization and height. Metallic bracelet asterisk on right wrist is also seen. Findings of radiography of the long bones allowed us to make anthropomorphic measurements that led to estimates of the children's ages [ 22 ].

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Such measurements were difficult because of the superimposition of the bones caused by the particular position of the bodies Fig. Radiograph of lower limbs reveals excellent bone mineralization.

Measurement of long bones was difficult because of superimposition of bones.