A 22-year-old man was found dead in his room, lying on his bed, with a kitchen knife embedded in his thorax. The external examination revealed only 1 deep incised horizontal wound in the third left intercostal space beside the sternum. There were no hesitation marks or defense injuries. On both flexor sides of the wrists, the forearms, and the arms and on the right and the left side of the neck, there were several old transversal cut scars. At the autopsy, once the single-edged knife was removed, and after a median sternotomy, the penetration depth of the stab wound revealed an incision of the left pleura, the pericardium, and the transfixed heart, from the anterior to the posterior side, ending on the seventh thoracic vertebra. Toxicological screening resulted as negative. Death occurred as a result of hemorrhagic shock after deep myocardial injuries. A psychiatric history of paranoid schizophrenia; the old scars, which were marks of previous attempted suicides; and the position of the weapon suggested that it was a suicide caused by a single strong stab wound in the cardiac region. This unusual manner of self-stabbing with a single stab to the heart without hesitation wounds was important to exclude other causes of death.

In January 2014, a dead woman was found lying near the back entrance of a building belonging to Bari University Hospital compound. After the external examination and identification of the corpse, through history, circumstances, and postmortem findings, it was supposed that the woman probably committed suicide, by jumping from the nearby building. But only after additional investigation of the scene was it possible to locate the window through which the victim had jumped, by assessing the height from which she leapt. We underline the importance of the examination of the scene. It has to be done with circumspection, even in cases that could be considered routine, paying attention to details, not excluding things that, at first glance, seem to be unnecessary. Inspection needs time, patience and accuracy, knowledge, competence, and intuition and must be the result of an efficient team action. Furthermore the occurrence of suicides, particularly jumping from a height, among immediate postdischarge psychiatric patients, stresses the importance of immediate follow-up treatment and alternative preventive strategies, considering, of course, the feasibility of structural means.