Haemolytic staining of the intima of the aortic root – A useful pathological marker of freshwater drowning?

Byard, Roger W.; Cains, Glenda; Tsokos, Michael

doi:10.1016/j.jcfm.2006.01.008

Cited by 22 publications

(10 citation statements)

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“…9 Finally, in a small prospective study, we found intense red hemolytic staining of the aortic root intima with no discoloration of the pulmonary trunk only in freshwater drowning, and not in controls or victims of saltwater drowning. 10 Cases with established putrefaction usually showed equally intense dark red discoloration of both the pulmonary artery and the aorta. 10 There has been no data available, however, on the possible sensitivity of hemolytic staining as a marker of freshwater drowning.…”

Section: Discussionmentioning

confidence: 99%

“…10 Cases with established putrefaction usually showed equally intense dark red discoloration of both the pulmonary artery and the aorta. 10 There has been no data available, however, on the possible sensitivity of hemolytic staining as a marker of freshwater drowning.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to putrefaction, sepsis, coagulopathies, or thermal injuries where adverse intravascular conditions lead to break down of erythrocyte membranes. 10 Given that hemodilution will result in a similar outcome, and that hemodilution is a recognized consequence of freshwater drowning, [21][22][23][24] it is perhaps surprising that such staining is not found more often in freshwater drowning. Although the absence of hemolytic staining of the aortic root intima in cases of suspected freshwater drowning may be of limited diagnostic use, the presence of this sign without superimposed changes of putrefaction should add confidence to the likelihood of a fresh water drowning death.…”

Section: Discussionmentioning

confidence: 99%

“…6 -8 Studies undertaken by our group have suggested that it may represent a specific, but not particularly sensitive marker of freshwater drowning. 9,10 The following study was undertaken to provide some indication of how often it had been documented in a series of cases of freshwater drownings in a medicolegal setting.…”

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confidence: 99%

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Hemolytic Staining of the Intima of the Aortic Root in Freshwater Drowning

Tsokos¹,

Cains²,

Byard³

2008

American Journal of Forensic Medicine &Amp; Pathology

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A retrospective study was conducted of files at the Institute of Legal Medicine in Hamburg, Germany from 1998 to 2003 of all cases of drowning where there was no putrefaction, to document the rate of recording of hemolytic staining of the intima of the great vessels. All cases had full police investigations with reviews of previous histories, circumstantial evidence, and autopsy findings. A series of control subjects who had died of various natural and nonnatural, nondrowning deaths, matched for age, sex, and postmortem interval, was also reviewed. One hundred twenty cases of freshwater drowning were identified. Drowning occurred in a garden pool in 1 case, in a bath in 2, and in the river Elbe in 117. The age range was from 2 to 91 years (mean = 55 years; M:F = 1:1.8). Hemolytic intimal staining of the aortic root was documented in 6 cases (6 of 120; 5%). This consisted of reddened discoloration of the proximal portion of the aortic root, without any significant staining of the proximal pulmonary artery. No significant hemolytic staining of the intima of the great vessels was recorded in any of the 120 control cases. Although under-reporting of findings may occur in retrospective analyses, this study has shown that at least 5% of freshwater drowning cases showed differential staining of the pulmonary trunk and aorta, with hemolytic discoloration of the aortic intima. When present, hemolytic staining of the aortic root intima may be a useful and possibly under-recognized corroborative sign of freshwater drowning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Hemolytic Staining of the Intima of the Aortic Root in Freshwater Drowning

Tsokos¹,

Cains²,

Byard³

2008

American Journal of Forensic Medicine &Amp; Pathology

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“…In the current issue of Forensic Science Medicine and Pathology the potential significance of differential staining of the aortic and pulmonary trunks is discussed [17]. This is something which has been well recognized in the German, but not the more recent English, literature as a finding in fresh water drowning that is caused by intravascular hemolysis [18][19][20][21]. On occasion new observations, even from veterinary practice, are made which may help to clarify particular issues, such as impacted endobronchial sand casts when drowning has occurred in areas of sea turbulence [22].…”

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confidence: 99%