Unassisted smothering in a pillow

Abstract

We report the case of a 33-year-old man admitted to a psychiatric hospital because of paranoid schizophrenia. The man was found dead lying in his bed with the face pressed against a pillow and with elevated buttocks. The autopsy did not reveal a cause of death. The histological findings displayed the signs of the haemorrhagic-dysoric syndrome with acute emphysema; these findings are pathognomonic of obstructive asphyxia. The adverse effects of the neuroleptics demonstrated by the toxicological findings may have accelerated the loss of consciousness and facilitated the unusual position of the body. On the basis of the clinical history, the autopsy findings, the histological features and the toxicological results, asphyxia due to smothering was diagnosed as the cause of death.

Injuries due to Asphyxiation and Drowning

“…This usually affects people who are debilitated due to illness or intoxication (Schmeling et al 2009). In homicidal asphyxiation, the perpetrator presses the victim's face into soft objects like bed linen.…”

Delayed asphyxia due to inhalation injury

“…The classical macro-microscopic correlates of asphyxia include acute pulmonary emphysema and congestion, focal hemorrhagic oedema, microembolism, and alveolar macrophages and giant cells [17][18][19]. In our case, acute pulmonary emphysema was evident, whilst the other morphological signs of asphyxia could not be detected in the investigated lung samples.…”

Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL)

“…Moreover, because the sensitivity of warfarin might alter after surgery [12], INR should be measured after the resumption of anticoagulation therapy. At any rate, since the ageing of the retroperitoneal haemorrhage might be estimated at a few days from the results of the histological examinations [13][14][15][16], the anticoagulation therapy resumed after the ESWL might have affected the massive haemorrhage from the injuries of the right kidney and inferior vena cava caused by ESWL, although we could not investigate the right kidney because it could not be obtained from the hospital. In other words, it is likely that the injuries of the right kidney and inferior vena cava had been attributed to ESWL; however the bleeding had been slight before the resumption of anticoagulation therapy so that iron staining was negative.…”