Remarkable findings in suicidal hanging

Abstract

A 71-year-old man was found dead in his apartment hanging by a tie that was fixed to the upper hinge of a door. His feet were touching the ground. It was known that he had tried to commit suicide before. At medico-legal autopsy a single furrow was found on the neck with a ligature knot behind the left mandibular angle. Dissection of the neck's soft tissue in layers revealed bilateral fresh hemorrhages in the pharyngeal tonsils with macroscopic delineation of gland follicles (Fig. 1). Fractures of both superior horns of the thyroid cartilage, superficial hemorrhage in the tongue's base, and petechiae of the facial skin and conjunctivae were also present. Except for brain swelling, pulmonary edema, and severe generalized atherosclerosis, no other findings were observed. Toxicological investigations were negative. The cause of death was declared as hanging and the manner of death was ruled suicide. Case 2A 74-year-old man was found hanging from the railing of a bridge, freely suspended by a hemp rope with an estimated drop of 3.5-4 m. The deceased was 160 cm tall and weighed 77 kg. The 1 cm thick rope compressed the neck with a knot on the anterior area of the neck forming a loop that ran above the laryngeal protuberance. The loop ended in a fixed ligature knot behind the left ear. At external examination, dried saliva was found coming out of the right corner of the mouth, draining down over the chin. Autopsy revealed bilateral symmetrical hemorrhages at the sternal insertion of the periosteal-clavicular origin of the sternocleidomastoid muscles, and a complete laceration of all tissue layers between the cricoid cartilage and the hyoid bone that crossed the upper part of the thyroid cartilage and exposed the laryngeal mucosa. The trachea contained a small amount of fine froth with no signs of blood aspiration. A full-thickness transverse laceration, as well as superficial tears in the intima of the right common carotid artery, were also seen proximal to the bifurcation (Fig. 2). Hemorrhages (''Simon's bleedings'') beneath the anterior longitudinal ligament of the thoracic and lumbar spine were also present. Toxicological analysis was unremarkable. Case 3A 34-year-old man was found hanging in free suspension by a rope in his apartment. According to the man's medical history he had suffered from a depressive disorder. A suicide note was found in the flat. At external examination, a strangulation mark was visible with signs of suspension below the left ear. At autopsy, the most remarkable finding was hemorrhage beneath the anterior longitudinal ligament L. Tattoli

Forensic Interpretation and Importance of Simon’s Bleeding, Amussat’s Sign and Other Typical Findings of Hanging as Diagnostic Signs

“…The main task of the forensic pathologist in cases of hanging is to determine whether the hanging occurred while the person was alive or if the body of the deceased was placed intentionally to simulate hanging to hide homicide [ 9 ]. Depending on the level of compression, and the force applied, there are few typical findings in cases of hanging, which are proven to be vital signs in cases of hanging [ 9 ]. Depending on the level of compression, fractures of the hyoid bone and thyroid cartilage with bruises of the surrounding soft tissues might occur [ 1 , 10 ].…”

Simon’s sign: Case report and review of the literature

“…As reported in the literature, the violent overstretching and caudal-rostral hyperextension of the spinal column act as the predominant forces. 7 The neck structures were injured due to the strain caused by the gravitational pull by the body's weight. Specifically, the injury to the left carotid artery, as seen in this case, can be attributed to the direct pressure of the ligature on the neck, causing a transverse laceration of the intimal layer of the vessel (Figure 3).…”

“…7 case 3Male 34Hanging EE: hanging mark with signs of suspension below the left ear IE: haemorrhage beneath the anterior longitudinal ligament of the cervical spine (Simon's sign) Cvetkovi c et al3 Male 27Fall from a height EE: laceration wounds on the vertex of the head, cortical contusions, bruises, excoriations, and laceration wounds of the face IE: rupture of the dura mater beneath the skull fracture, superficial lacerations of the right lung, haemorrhages beneath the anterior longitudinal ligament of intervertebral discs (Simon's sign), lacerations and contusions of the right lobe of the liver…”

Pneumomediastinum and Cervical Soft Tissue Emphysema as an Important Vital Sign in Hanging: An Autopsy Based Prospective Study

“…Both mechanisms are compatible with the finding of air in the visceral space around the trachea, esophagus and big vessels of the neck, the structures serving as guides for air spread. Cases of airway mucosal injuries with complete disruption, including decapitation and transverse laceration of upper airways, have been reported in hanging deaths [19,20]. Gill et al have reported two cases of crico-tracheal disruption owing to hanging which lead to the development of local subcutaneous emphysema [21].…”