Macromorphology and histology of intramuscular hemorrhages in cases of drowning

Abstract

In a prospective autopsy series of 39 cases of fatal drowning, the detailed dissection of the skeletal muscles of the neck, anterior/posterior trunk and the upper extremities in layers revealed intramuscular hemorrhages of different size and shape in 20 cases (51.3%). Light microscopy examination showed a premortal (vital/agonal) type of muscular alteration in 7 (50%) out of 14 macroscopical hemorrhage-positive cases. These hemorrhages and histological muscle alterations are attributed to agonal convulsions, hypercontraction and overexertion of the affected muscle groups. As long as no cutaneous or subcutaneous hematomas above the hemorrhages can be found, these autopsy findings (with special reference to histology) can serve as an additional criterion concerning the differentiation of drowning and another cause of death.

Lesions associated with drowning in bycaught penguins

“…The lesions that were observed in the lungs of drowned penguins parallel those described in wet drowning in humans, with marked distension of lungs with foamy liquid (Püschel et al 1999, Salomez & Vincent 2004, Lunetta & Modell 2005. The studied penguins, however, did not have a substantial quantity of foam and frothy liquid in the upper airways nor multifocal subpleural haemorrhages (Paltauf's spots) that are often observed in humans (Salomez & Vincent 2004, Lunetta & Modell 2005).…”

“…The studied penguins, however, did not have a substantial quantity of foam and frothy liquid in the upper airways nor multifocal subpleural haemorrhages (Paltauf's spots) that are often observed in humans (Salomez & Vincent 2004, Lunetta & Modell 2005). The overall volume of the lungs was markedly increased, however the presence of liquid in the pulmonary airways did not seem to be accompanied by significant loss of structure or rupture of the parabronchial septa, in contrast to the emphysema aquosum that is classically described in humans (Püschel et al 1999, Salomez & Vincent 2004, Lunetta & Modell 2005. If inhaled into the lungs, the hyperosmotic nature of seawater is expected to lead to an intense outflow of intravascular fluids to the airways, resulting in haemoconcentration and severe pulmonary oedema (Timperman 1972, Modell 1993, Lunetta & Modell 2005.…”

“…The presence of haemorrhages in skeletal muscles, particularly in the neck and trunk, are frequently observed in drowned humans as a result of agonal convulsions, overexertion and hypercontraction (Püschel et al 1999, Salomez & Vincent 2004, Lunetta & Modell 2005. The rhabdomyolysis and haemorrhage in the neck and pectoral muscles of drowned penguins, without lesions in the adjacent subcutaneous tissue, may have resulted from exertional myopathy or agonal movements.…”

Ausgeprägte intramuskuläre Hämorrhagien vitaler Genese bei letaler suizidaler Strombeibringung

“…Differentialdiagnostisch sind zu Lebzeiten erfolgte äußere Gewalteinwirkung, außergewöhnlich starke Muskeleigenkontraktionen oder Muskelüberstreckung [12] wie auch eine postmortale Entstehung durch Transport-oder Bergungsmaßnahmen [21] in Erwägung zu ziehen. Im Falle mechanisch-stumpfer äußerer Gewalteinwirkung ist regelhaft eine Einblutung in das korrespondierende Unterhautfettgewebe zu erwarten, so dass sich insbesondere beim Fehlen eines derartigen Befundes die Frage nach der Genese der Muskelblutungen aufdrängt [20].…”

“…Zur histologischen Unterscheidung vitaler und postmortaler Muskelschädi-gungen liegen umfassende Untersuchungen in der forensisch-pathologischen Literatur vor [4,12,17,18,19,20]. Es lassen sich hierbei verschiedene Schädigungsmuster unterscheiden, welche eine eindeutige Diskrimination des Schädigungszeitpunkts (antemortal vs. postmortal) zulassen.…”