Pulmonary micromorphology in fatal strangulations

Grellner, Wolfgang; Madea, Burkhard

doi:10.1016/0379-0738(94)90326-3

Cited by 31 publications

(10 citation statements)

References 11 publications

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“…Significant findings in connection with deaths from asphyxia due to obstruction of the respiratory passages are acute pulmonary emphysema in combination with intra-alveolar pulmonary edema, fresh intra-alveolar hemorrhages involving >5% of the pulmonary tissue ("hemorrhagic-dysoric syndrome"), and occasionally microembolism syndrome with migration of bone marrow cells into the pulmonary circulation [6,9,10,16,41,44]. In cases of primary survival intraalveolar siderosis can be found [5,11,30].…”

Section: Discussionmentioning

confidence: 96%

Three subsequent infanticides covered up as SIDS

Bohnert¹,

Perdekamp²,

Pollak³

2004

Int J Legal Med

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Within a period of 9 years a young woman lost 3 daughters during infancy and each time death was attributed to the sudden infant death syndrome. The children had different fathers and died at the ages of 11 weeks, 7 weeks and 2 weeks, respectively. A fourth daughter survived and lives separated from the mother together with her father and is healthy. At autopsy the last of the three deceased infants did not reveal any pre-existing pathological organ findings, except for acute pulmonary emphysema and extensive intra-alveolar bleeding. As a consequence the strong suspicion of mechanical suffocation arose. Subsequent police investigations produced incriminating clues that the first two children had also been suffocated. On confrontation with the autopsy findings and investigation results, the woman confessed that she herself had killed the first two infants by pressing a cushion on their faces. In the case of the third death the baby had been smothered by the child's father who in agreement with the mother put a plastic film on mouth and nostrils.

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Section: Discussionmentioning

confidence: 96%

Three subsequent infanticides covered up as SIDS

Bohnert¹,

Perdekamp²,

Pollak³

2004

Int J Legal Med

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“…Microscopic pulmonary findings in mechanical asphyxia are characterised by local atelectasis and emphysema, congestion, intra-alveolar and interstitial edema, and hemorrhage, although none of these is specific to the cause of death (Brinkmann and Püschel 1981;Grellner and Madea 1994). In this study, we evaluated the usefulness of SP-A as a practical diagnostic marker of fatal mechanical asphyxia in forensic autopsy cases.…”

Section: Introductionmentioning

confidence: 97%

Immunohistochemical investigation of a pulmonary surfactant in fatal mechanical asphyxia

Zhu

Ishida

Fujita

et al. 2000

International Journal of Legal Medicine

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We evaluated the usefulness of pulmonary surfactant protein A (SP-A) as a practical diagnostic marker of fatal mechanical asphyxia in forensic autopsy cases. A total of 27 cases of asphyxia were examined histologically and immunohistochemically and compared with a control group consisting of 16 cases of poisoning (n = 9) and peracute death (n = 7). Both groups showed histological findings of local atelectasis and local emphysema, congestion, intra-alveolar and interstitial edema in most cases and pulmonary hemorrhages in some cases. The mechanical asphyxia group showed a significantly increased intensity of SP-A staining in the intra-alveolar space accompanied by many massive aggregates in approximately 60% of cases, which was not found in the control group. These structures may be interpreted as aggregates of pulmonary surfactant released from the alveolar wall due to enhanced secretion caused by strong forced breathing or over-excitement of the autonomic nervous system by mechanical asphyxia. The results of our investigation suggest the practical usefulness of the immunohistochemical detection of SP-A in distinguishing mechanical asphyxia from other types of hypoxia.

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“…Intra-alveolar haemorrhage has been reported as a common finding in deaths due to compression of the neck and in "sudden infant death syndrome" (SIDS) [23,24]. Intraavleor haemosiderin-laden macrophages have been reported in the lungs of drug addicts, where previous hypoxia and resultant haemorrhage have been proposed as the mechanism of production [25].…”

Section: Discussionmentioning

confidence: 99%

Munchausen syndrome by proxy and intra-alveolar haemosiderin

Milroy

1999

International Journal of Legal Medicine

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Munchausen syndrome by proxy is characterised by the invention of a false history and/or the deliberate inducement of a factitious illness by parents in their child. First reported as a disorder of mothers, this syndrome is now recognised to have male perpetrators. One of the most common characteristic presentations is with the child allegedly suffering repeated apnoeic attacks. These are in fact deliberately induced episodes of upper airway obstruction. The children of these parents are at great risk of serious harm or death if not recognised. The identification of smothering at autopsy is fraught with difficulty and the presence of intra-alveolar haemosiderin has been claimed to be a marker of previous smothering. A case of Munchausen syndrome by proxy is presented where there were deliberate acts of repeated partial smothering and where the finding of intra-alveolar haemosiderin at autopsy provided additional supportive evidence of smothering.

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Pulmonary micromorphology in fatal strangulations

Cited by 31 publications

References 11 publications

Three subsequent infanticides covered up as SIDS

Three subsequent infanticides covered up as SIDS

Immunohistochemical investigation of a pulmonary surfactant in fatal mechanical asphyxia

Munchausen syndrome by proxy and intra-alveolar haemosiderin

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