Postmortem diagnosis of hypothermia

Abstract

The identification of hypothermia as the cause of death has always been somewhat problematic in forensic pathology because of unspecific, inconstant, or even negative macroscopic and microscopic findings. Though the simultaneous presence of frost erythema, Wischnewski spots, hemorrhages into the synovial membrane, bloody discoloration of synovial fluid of the knee, and basal vacuolization of the renal tubular epithelial cells has been indicated as strongly supportive of fatal hypothermia, their absence does not allow the diagnosis of hypothermia to be ruled out. Postmortem biochemical investigations are valuable in detecting adaptation responses to cold stress and metabolic changes that occur following cold exposure. However, ethanol intoxication prevents appearance of adaptation responses to cold, rendering the diagnosis less obvious. Immunohistochemistry, postmortem imaging, and molecular pathology have shown promising results, although at present, they do not provide pathognomonic signs of fatal hypothermia. The aim of this article is to present a review of the literature covering the significance of different postmortem investigations that are associated with hypothermia fatalities.

Regarding “Lethal hypothermia – a sometimes elusive diagnosis”

“…Among other considerations concerning death due to hypothermia, the article summarized major autopsy signs that occur with variable frequency: pink discoloration of the skin over the extensor surfaces of large joints, respiratory and other skeletal muscle hemorrhage, superficial gastric erosions, or Wischnewski spots, vacuolization of renal tubular cells, acute pancreatic inflammation with fat necrosis, fatty change in cells of the heart, liver and kidneys, etc.However, one of the quite important autopsy signs is missing, described not only in papers [2][3][4][5], but also in some of the major forensic medicine textbooks in English, written by German authors [6,7]. The "inner knee sign" is characterized by hemorrhages of the synovial membrane and bloody discoloration of synovial fluid, and was first described as "innere Kniebefunde" by the German author, Weinke, in 1996 [2].…”

Lethal hypothermia – a sometimes elusive diagnosis

“…The findings at autopsy can be quite subtle and there is a lack of accord on the necessary features required to make the diagnosis [1][2][3][4]. It is even less clear to what degree hypothermia may contribute to lethal outcomes in the presence of significant underlying organic illnesses.…”

“…Issues occur with differences in diagnostic practices arising from the nonspecific and subtle nature of findings at autopsy, and the possibility of inflicted injury due to the sometimes bizarre nature of behavior that may occur before death [17][18][19]. Biochemical markers are not currently routinely assessed in these cases [2,20].…”

Polish forensic medicine A.D. 2016 – report of the National Consultant

“…Przykładem takiej współpracy międzynarodowej są prowadzone od 2011 r. w ZMS-ie w Lublinie poszukiwania biochemicznych markerów śmiertelnej hipotermii [21][22][23], jak również wieloletnia kooperacja ośrodka krakowskiego w obszarze pośmiertnych badań obrazowych [24][25][26] z jednym z najlepszych ośrodków medycyny sądowej na świecie (University Center of Legal Medicine w Lozannie i Genewie), którego czołowi reprezentanci (prof. S. Grabherr, doc. C. Palmiere) uczestniczyli w tegorocznym seminarium Advances in postmortem imaging and biochemical investigations w Lublinie [20,27].…”

“…One example of such international cooperation is the search of post-mortem biochemical markers of hypothermia carried out by the FMU in Lublin since 2011 [21][22][23], as well as long-term cooperation of the Krakow center in the area of post-mortem imaging examination [24][25][26] with one of the finest legal medicine centers in the world (University Center of Legal Medicine in Lausanne and Geneva), whose leading representatives (prof. S. Grabherr, doc. C. Palmiere) participated in this year's seminar on Advances in postmortem imaging and biochemical investigations in Lublin [20,27].…”