Forensic-medical assessment of pathomorphological changes in the myocardium in blunt chest trauma with an isolated heart contusion

A total of 37 autopsy cases were divided into two groups. Group 1 consisted of 17 victims who had died of closed blunt trauma of the chest with isolated heart contusion made by fists, feet in shoes. Group 2 (control) consisted of 20 cases of sudden death of ischemic heart disease because of atherosclerotic cardiosclerosis. Fragments of the heart containing endocardium were studied on the microscope JEIL-SM200 (Japan). Endocardium pathomorphology was represented by relief changes of the endocardium, structural arrangement of separate groups of muscular fibers above the endocardium surface, hemorrhages and blood clots, endotheliocyte desquamation, prelacerations, lacerations and destruction of the endocardium.     

Detection and assessment of microparticles in the area of periosteum damage from blunt trauma

Periosteal injuries and deposition of trace corpuscles on the periosteum resultant from stroke with blunt hard objects and in car or railway accidents are analyzed. The greatest number of trace corpuscles of different origin are formed as a result of direct strike of a hard blunt object against the bone surface. They are deposited at the site of periosteal injury, which should be removed and examined by special methods. This will help determine the mechanism of injury and identify the object with which the injury was inflicted.     

Forensic-medical assessment of the damage to sex organs unrelated to sexual crimes

The analysis was made of forensic medical examinations for assault (427 cases) and commission examinations made in the department of complex expert examinations for decision on the relation between pregnancy interruption and injury (46 cases). A documented posttraumatic stress reaction to assault damage to health is determined with consideration of duration of psychic rehabilitation. The author presents cases from her practice of direct and indirect damage to sexual organs observed in different situations and their effect on pregnancy interruption.     

Cardiac rupture following blunt trauma

A case of cardiac rupture following blunt trauma with no additional injuries is described. This can be a difficult diagnosis because of the presence of additional injuries and the lack of clinical symptoms. Here, there was a rupture of the pericardium, all chambers of the heart and the thoracic aorta.     

Suicide by blunt force trauma

Suicide by self-inflicted blunt force injury is rare. The authors report a case of a 48-year-old man who initially appeared to have died of a homicidal beating. The pertinent autopsy findings consisted of blunt force closed head injury combined with numerous cutaneous abrasions and contusions of the entire body. Further inquiries confirmed a medical history of paranoid schizophrenia and a previous attempt at suicide. This case represents an extreme example of severe blunt trauma sustained during fatal self-mutilation and masquerading as a homicide. It also underscores the importance of correlating a thorough background investigation with autopsy findings in determining the appropriate manner of death.     

Azygos vein laceration due to blunt trauma

The azygos vein ascends along the thoracic spine through the mediastinum and drains into the superior vena cava at the level of the fourth thoracic vertebra. Fracture-dislocation of the mid-thoracic spine, as a result of blunt thoracic trauma, can tear the azygos vein. Four such fatal cases (three motor vehicle accidents and one fall) were studied, only one of which was recognized prior to death. The vein can also be torn, in the absence of skeletal injuries, by horizontal acceleration/deceleration forces. The pathologist must consider azygos vein laceration as a possible cause of either hemothorax or hemomediastinum or both in a victim of a blunt chest trauma, if that individual had persistent hypotension during the few hours before death and no identifiable source of hemorrhage can be found postmortem in sites such as the heart, great vessels, lung, and chest wall. A fracture-dislocation of the thoracic spine may not necessarily be present. Azygos vein laceration seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is probably more frequent than is implied by the few cases described in the medical literature.     

Ventricular septal necrosis after blunt chest trauma

Ventricular Septal Defect (VSD) after blunt chest trauma is a very rare traumatic affection. We report here a case of blunt chest injury-related VSD and pseudoaneurysm. A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edema and echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely the intracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue some hidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinical sequelae.     

Delayed cardiac rupture due to blunt chest trauma

A 7-year-old boy fell from a 2.5-m height and suffered contusion of the thorax with hematoma in the soft tissues of the lateral chest wall. The rib cage itself remained intact. After 3 days, there was only local pressure sensitivity of the left hemithorax. On day 8 after the trauma, the child, who up to then had seemed to be in good health, suddenly died during lessons at school. Autopsy revealed a full-thickness rupture of the left ventricle with resultant cardiac tamponade. The macroscopic and histopathologic findings are presented and discussed.     

Forensic-medical assessment of terroristic chemical attacks

By potential damage, chemical terroristic attacks are much more dangerous than terroristic bombing. To fight chemical terrorism it is necessary to create the system of medical-environmental defense of the population. In line with emergency medicine, forensic medical service is a very important element of the antiterroristic defense. The activity of forensic-medical experts in the field of terroristic chemical attack is analysed.     

Fatal blunt trauma of the larynx in a child

We report an autopsy case of an 11-year-old girl who suffered mechanical asphyxia from falling off the metal bars in the playground. This autopsy case is interesting because of the atypical trauma and lesions. To our knowledge there has been no similiar published case reports in the forensic literature. The young age of the victim, the setting and the pattern of the injuries are rare in a fall at playground by a child.     

The clinico-morphological basis for a diagnosis of diffuse axonal brain damage in head trauma

The most typical neurologic signs and variants of computer-tomographic cerebral picture in diffuse axonal lesion of the brain are presented. Dynamics of pathomorphologic changes depending on duration of posttraumatic periods is detected.     

Forensic-medical aspects in assessment of damage to health as the result of chest and low back spinal traumas

By the law of the Russian Federation, forensic medical examination is obligatory to assess damage to health in chest and low back spinal traumas. In persons who survived spinal trauma the assessment of its severity is regulated by the rules of assessment of the severity of bodily damage and harm to health. Difficulties arising in this assessment are outlined. Damage to health is proposed to be evaluated not only by clinical data on the condition of the patients but also by macro- and microscopic results of forensic-medical examination of the dead body, by the presence and severity of edema of the spinal cord tissue.