Death in a fold-away bed

The term "death in abnormal body position" refers to deaths caused by a position-induced impairment of the vital functions of respiration and circulation. In the described case from the autopsy material of the Berlin Institute of Legal Medicine (CCM), the 82-year-old woman died in a folded up fold-away bed in a fixed head-down position. Death was caused by the combined effect of neck compression, traumatic asphyxia and head-down position.     

Two cases of accidental asphyxia by neck compression between bed bars

Two cases of asphyxia due to compression of the neck between the side bars of a bed in elderly subjects affected by neuropsychiatric pathologies are presented. In both cases no lesions were found on the skin or in the anatomic structures of the neck. The absence of lesions made determining the cause of death difficult. Generic evidence of asphyxia (acute pulmonary emphysema and petechiae) allowed a diagnosis to be formulated. The discovery of the object that caused the death was possible only with information regarding the circumstances and inspection of the scenes of the deaths.     

Asphyxiating death due to basal lingual cyst (thyroglossal duct cyst) in two-month-old infant is potentially aggravated after central catheterization with forced positional changes

There are various causes of possible upper airway obstruction in infants. Particularly, large cysts on the base of tongue may cause severe airway obstruction by a mass effect on the hypopharynx and by displacing the epiglottis. Of these basal lingual cysts, thyroglossal duct cyst is rare but occasionally its remnants can be found at the base of the tongue. Although they are pathologically benign, basal lingual cysts may result in death by asphyxia. There are a few reported cases of asphyxia caused by basal lingual cyst. All died suddenly in the bed or cot while sleeping without any significant symptoms and signs. The authors experienced a unique case of death due to airway obstruction by basal lingual cyst (thyroglossal duct cyst), confirmed by postmortem examination, probably aggravated after central catheterization in 2-month-old infant who had open heart surgery for atrial and ventricular septal defect and report with a literature review.     

Asphyxia protracted after shaking trauma

A case of "shaken baby syndrome" (SBS) is reported. A 3 1/2 months old female baby has been found by his mother death in bed. The circumstances predicted a case of Sudden Infant Death Syndrome (SIDS), but the father, a disc-jockey, who had to look for the baby, had left a notice: "Gitti--i didn't want it, I don't know what had happened, I'm sorry!". The corpse of the baby had no external signs of violence. At the medicolegal examination we found small subarachnoidal and subdural hemorrhage from ruptured bridge veins and signs of prolonged asphyxia. Few hours later the father could be arrested. He told that he had shaken the baby, because she didn't stop crying. The infant lost conscious and he layed him down to the bed with his face below. Then he looked TV for at least a few minutes. After insufficient reanimation he had left the house. The court found the man to be guilty of fatal infant child abuse and convicted him to detention of 8 months. The main signs of SBS are discussed (subarachnoidal and subdural hemorrhage, intraretinal and periretinal hemorrhages, brain edema). Especially in the german speaking Europe many medical examiners are not familiar with this form of infant child abuse.     

Dirty diving. Sudden death of a SCUBA diver in a water treatment facility.

We report a case of a sudden death in a SCUBA diver working at a water treatment facility. The victim, an employee of the facility with a specialty in electronics, was a sport diver not qualified in commercial diving. While attempting to clean sludge from a blocked drain 25 ft under water, the diver was suddenly pinned against the drain valve when the sludge plug was broken up. We review the mechanics of the incident and the actual cause of death, asphyxia, as opposed to drowning. We believe this to be the first reported case of traumatic (pressure) asphyxia in a SCUBA diver.     

The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults--a 25-year study

A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19-86 years (mean=41.8 years) and of the females was 19-75 years (mean=38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes (N=37), industrial accidents (N=9), farm accidents (N=6) and entrapment beneath vehicles (N=5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.     

PMCT在机械性窒息方面的研究进展

机械性窒息是公安法医日常检案中最常见的死因之一.如何快速准确的判断死者是否为机械性窒息死亡、以及作案手段是判断案件性质、指引案件侦破方向的重要因素.在法医鉴定过程中,诊断机械性窒息需要结合尸体体表征象、尸体内部征象、组织病理学检验等多方面综合判断.PMCT在骨折的检测、异物的检测和气体的检测方面具有极大的优势,在许多国...     

Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases

Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia.     

Death following atypical compression of the neck

The authors present 3 cases of asphyxia caused by atypical compression of the neck by the metal bed bars fitted at the sides of the bed to prevent falling out. These occurred in 3 elderly women living in nursing homes, confined to bed by severe neuropsychiatric disturbances. In all 3 cases, the minor nature of the skin lesions and absence of blood infiltrations in the anatomic structures of the neck had made it difficult to diagnose the cause of death. Inspection of the rest homes, together with the autopsy findings (acute pulmonary emphysema, conjunctival petechiae, and dark, fluid blood), enabled identification of asphyxia as the cause of death and its causal agent as the bed bars.     

Inflicted compressional asphyxia of a child

Compressional or traumatic asphyxia is a well recognized entity to most forensic pathologists. The vast majority of reported cases have been accidental. The case reported here describes the apparent inflicted compressional asphyxia of a small child. A review of mechanisms and related controversy regarding proposed mechanisms is discussed.     

Forensic medical specificity of death in atypical sexual behavior: asphyxiophilia, autoerotism

The diagnosis of death of autoerotic asphyxia has not been virtually stated by Russian forensic medical expert. All such cases were interpreted as mechanical asphyxia entailing suicide, and "accidental" or "fatal" death. The authors observed, during the recent 5 years, 10 lethal cases in different-type autoerotic practice. Strangulation asphyxia was the death cause in 7 cases. Compression asphyxia, inhaling of glue vapor and electric shock caused death, each in one case. Death of asphyxia seizes to be exceptional; it is rather a regular phenomenon in the present-day life, which needs a proper research from 2 standpoints--etiopathogenesis, and forensic medical diagnosis.     

Lactic acid concentrations in vitreous humor: their use in asphyxial deaths in children

Lactic acid concentrations in brain tissue of humans have been shown to increase with an extended agonal period. Infants and children dying from various causes are undergoing different stress conditions terminally and the postulate of this study is that natural death cases and traumatic asphyxia cases are characterized by varying agonal periods, the former being somewhat prolonged with the latter being rather brief. One-hundred-and-two cases of infants and children were examined for vitreous humor lactic acid concentrations. They were divided into two major categories, Sudden Infant Death Syndrome (SIDS) and non-SIDS cases. SIDS was further divided into SIDS without additional findings and SIDS with secondary findings which contributed to death. The non-SIDS category included traumatic asphyxia cases as well as those dying from blunt trauma, known respiratory diseases, and other causes. Categorical mean values and standard deviations were calculated. The vitreous humor lactic acid mean value for traumatic asphyxia was significantly lower than the mean value for SIDS. Also the mean value for known respiratory diseases was statistically lower than the mean value for SIDS with secondary findings. These findings are probably suggestive of agonal time differences and may be a reflection of the various mechanisms of death.     

An unusual suicide case by combination of choking and hanging

ABSTRACT: A 40-year-old man was found dead in his prison cell, hanging on a twisted bandage tightened around his neck. His permanent metal tracheostomy tube was completely corked with a piece of paper wrapped with transparent cellophane from a cigarette case. After police investigation and complete autopsy, suicide was determined as the manner of death. Although suicides by 1 form of asphyxia are relatively common, combination of several different forms of asphyxia is far less frequent. We present this unusual and very rare case of suicide by combination of 2 forms of asphyxia, that is, choking and hanging, along with autopsy findings and discussion.     

2633例机械性窒息法医尸检资料回顾性研究

本文根据湖北省部分地区1957～1986年间尸检记录,收集并分析了2633例机械性窒息死的出现率、案情性质、城市与乡村的差别等问题,为法医学实践提供了可供参考的资料。     

Positional asphyxia: reflection on 2 cases

Positional asphyxia, a fatal condition arising because of the adoption of particular body positions, causing mechanical interference with pulmonary ventilation, can occur in various circumstances that are likely to come under the observation of the specialist in legal medicine (work, car accidents, torture, kidnapping, etc.). It is difficult to diagnose the cause of death in such cases because they generally present with an aspecific anatomopathologic picture. In some situations, positional asphyxia can be hard to distinguish from asphyxia because of chest compression. The main difference is in the way the event occurred: whether the particular position causing the asphyxia had been adopted by choice or by compulsion or necessity when an extrinsic mechanical action would result in traumatic asphyxia. The diagnosis of positional asphyxia is essentially based on 3 criteria: the body position must obstruct normal gas exchange, it must be impossible to move to another position, and other causes of natural or violent death must be excluded. To illustrate the main physiopathologic and diagnostic causes of positional asphyxia, the authors report 2 cases taken from the records of events that came under the observation of the Medico-Legal Sector of Bari University Hospital throughout the last 10 years.     

Postmortem dog bites after sexually motivated homicide with multiple stab wounds--differential diagnostic aspects

The body of a 20-year-old woman that had undergone significant putrefaction was found lying on the bed of her apartment in a supine position. The legs were straddled and apart from a T-shirt, she was naked. The inner side of the right thigh showed a circumscribed 20 cm x 40 cm defect exposing the underlying muscles. The wound margin was ragged and superficial scratch-type abrasions were found in the vicinity of the injury margin. The investigating police officers classified the injuries to be caused postmortem by a crossbreed dog that was inside the apartment. No other signs of external force were found on the body at the death scene and due to the previous history of the deceased, a drug death was assumed. Autopsy revealed 13 vital stab wounds in the neck and aspiration of blood in the lungs as well as signs of manual strangulation. The observed coincidence of injuries due to postmortem animal depredation and stab wounds, although in different localization, can be regarded as a rare entity in the light of the literature. The morphological appearance of traumatic injuries due to other causes can be modified by the simultaneous presence of postmortem injuries caused by animals and difficulties can arise concerning the differential diagnosis especially under poor conditions (e.g. advanced putrefaction) at the death scene.     

Mesh-sided cots — yet another potentially dangerous infant sleeping environment

Two cases of accidental asphyxia involving an 11.5 month old boy and a 3.5 month old boy who each died after being trapped between the elastic mesh side of their cots and the cot mattress are reported. In both cases the original cot mattress had either been replaced or augmented by a less well fitting, thicker mattress. Particular problems that exist with these type of mesh sided cots are the potential for considerable stretching of the side of the cot admitting the relatively larger, poorly supported infant head, with elastic recoil of the mesh holding the head in potentially dangerous positions. To help determine whether accidental asphyxia has occurred, death scene examination in cases of sudden infant death during sleep should include reconstruction of the position of the body in the cot or bed, with careful examination of the structure of the cot/bed.     

Traumatic asphyxial deaths due to an uncontrolled crowd

Nine people died of traumatic asphyxia due to an uncontrolled crowd at a community basketball game in New York City in 1991. We reviewed the circumstances, postmortem findings, and the causes of death. The majority of people had petechiae of the conjunctivae and face consistent with chest compression. There were minimal superficial blunt injuries and no fractures or acute intoxications. These deaths are often incorrectly attributed to blunt force injuries, while the cause typically is asphyxia due to chest compression.     

Unexpected natural death secondary to intra-abdominal bleeding: report of one idiopathic spontaneous intraperitoneal hemorrhage case

A 39-year-old woman was found dead at home. She was single, foreign national, chronic alcoholic, and had given shelter to a compatriot for three days. This man found the deceased in her bed, after a night of heavy drinking. The emergency medical team observed numerous recent blue ecchymoses of the upper limbs. Because of the unclear circumstances, a medicolegal autopsy was ordered by the public prosecutor. Massive hemoperitoneum was diagnosed with no visible internal traumatic injury. Autopsy revealed hepatic and pancreatic abnormalities secondary to chronic alcoholism, which were confirmed by pathological study. The source of the hemoperitoneum was not identified despite careful visceral and vascular examination. The authors concluded that death was secondary to idiopathic spontaneous hemoperitoneum or abdominal apoplexy. The forensic literature on unexpected death due to massive nontraumatic intra-abdominal hemorrhage in association with liver cirrhosis is sparse, with only five cases reported, including the present case.