[gatagato]

While the term ‘‘asphyxia’’ literally means ‘‘without a pulse,’’
modern usage limits its application to cases where the body has
been exposed to a significant reduction in oxygen levels resulting
in impaired tissue oxygenation (delivery of oxygen to the body’s
cells). It can result in reduced levels of oxygen (hypoxia), or
absence of oxygen (anoxia). Unfortunately, there are no postmortem
laboratory tests that can be performed to make
a diagnosis of asphyxia as all bodies deoxygenate after death.
If asphyxia is considered pathophysiologically, there are four
stages where the transfer of oxygen can be compromised; i.e.,
oxygen reduction at the cellular level may be caused by
(1) decreased amounts of oxygen in the environment,
(2) reduced transfer from the air to the blood, (3) reduced
transport from the lungs to the tissues, and (4) reduced transfer across cell membranes


Fig. 1
Petechiae represent multiple pinpoint areas of bleeding due to rupture of congested blood vessels. They are not specific for asphyxia,
but are frequently present in certain types of death such as low suspension hanging where there has been compression of blood vessels.
Typically, they occur over the eyelids


Fig.2
Conjunctival petechiae in a case of low suspension hanging. In full suspension hanging, petechaie are usually absent as pressure on neck
vessels prevents congestion of the face


Fig.3
Petechiae of the eyelids in a case of low suspension hanging


Fig.4
Petechiae within the mouth in an asphyxial death


Fig.5
Laryngeal petechiae occurring in an asphyxial death


Fig.6
Petechiae may occur in a wide variety of situations, for example inside the lower eyelid in a death due to heart disease


Fig.7
A case of ‘‘simple’’ asphyxia (lack of environmental oxygen) with external airway obstruction by a plastic bag, in a suicidal drug overdose


Fig.8
A complex suicide utilizing a plastic bag over the head in addition to hanging


Fig.9
Injuries of the inner aspect of the lower lip in
a smothering death where pressure was
applied to the mouth and nose


Fig.10
Injuries to the inner cheek in a homicidal
smothering case


Fig.11
Obstruction of the inner airway by food is one of the most common causes of choking deaths. In this case, impacted food completely
occludes the larynx. Accidental choking on food or so-called ‘‘cafe´ coronary’’ occurs in demented individual with poor dentition or in
association with intoxication



Fig.12
A choking death in an intoxicated individual, with
occlusion of the larynx and upper trachea by a large
fragment of meat


Fig.13
A choking death due to lower airway obstruction by
multiple pieces of hot dog, evident within the trachea
and mainstem bronchi. Rounded foods such as
portions of sausage, carrots, and grapes are often
implicated in such deaths


Fig.14
A single portion of unchewed sausage wedged into a main bronchus (arrow) may be sufficient to cause death


Fig.15
In the case shown, choking had occurred on scrambled eggs which can be seen draining out of the mouth


Fig.16
Complete filling of the major airways with inhaled vegetable matter


Fig.17
Microscopy may reveal inhaled material in the smaller airways. A piece of vegetable matter in a bronchiole is highlighted by polarizing


Fig.18
An edematous (swollen) epiglottis and inlet to the larynx in a death related to anaphylaxis (allergic reaction)


Fig.19
Internal airway obstruction with a latex
examination glove (a) that has been removed
at autopsy (b)


Fig.20
An asphyxial death due to underlying natural
disease in a decomposed body. Note the
tumor occluding the laryngeal opening.
Although the tumor is a benign tumor of fat
tissue (a ‘‘lipoma’’), it was lethal because of its
location


Fig.21
Blockage of the upper airway due to tonsillar enlargement from infectious mononucleosis (glandular fever), an infection that causes
enlargement of the tonsils, lymph nodes, and spleen. The top of the tongue is seen in the lower portion of the photo


Fig.22
Marked narrowing of the airway at the back of the tongue
due to tonsillitis. The uvula can be seen in the center of the
field touching the two enlarged tonsils


Fig.23
Other natural causes of acute upper airway obstruction
include cysts of the back of the tongue or the epiglottis
(arrow) as illustrated


Fig.24
A case of traumatic asphyxia in which a worker
became pinned between an I-beam and
a descending elevator as he was leaning into the
elevator shaft


Fig.25
Petechiae of the inner eyelid in a case of traumatic
compression when a man became pinned
underneath an overturned tractor


Fig.26
Chest injuries occurring in a man who was working under a mobile home when it fell off of its supports and crushed him. Other than
florid facial petechiae, the only other injuries present at autopsy were the external chest injuries depicted here, that are in keeping with
the history of being compressed


Fig.27
Intense congestion of the face also occurs in crush asphyxia


Fig.28
In addition to facial congestion and petechiae, there may be marked conjunctival congestion and hemorrhage in crush asphyxia


Fig.29
Intense petechiae are usually found in the skin of the face, neck, and upper trunk in cases of crush asphyxia, except in areaswhere capillaries
are compressed by tight-fitting clothing, such as under a brassiere


Fig.30
Extensive posterior neck muscle hemorrhage identified in a motor vehicle collision-related traumatic asphyxial death


Fig.31
(a, b) Positional asphyxia related to acute ethanol intoxication. Note the fact that the body is essentially ‘‘upside down’’ and the neck is
markedly kinked


Fig.32
Lower facial petechiae in an individual who died of positional asphyxia (upside down body position) in a rollover motor vehicle collision


Fig.33
Extensive facial petechiae of the eyelid and forehead in another case of positional asphyxia


Fig.34
A full-suspension hanging death, with the feet totally off
the ground. The chair enables the decedent to tie the
rope to a high point


Fig.35
A partial-suspension hanging death, with the feet
touching the ground


Fig.36
A low-suspension hanging death where the victim presumably used milk crates to stand on in order to attach the ligature to an overhead
support


Fig.37
A hanging death with a rope used as a ligature


Fig.38
A hanging death in which an extension cord was used as the ligature


Fig.39
A suicidal hanging death utilizing a chain as the ligature


Fig.40
An x-ray of the case shown in >Fig. 39


Fig.41
A suicidal hanging death utilizing a bed sheet as
the ligature. Due to the broader area of the sheet
compared to thin ropes, marks on the neck may be
less obvious (see >Fig. 48)


Fig.42
A typical parchmented (dry) ‘‘furrow’’ mark is evident underlying the ligature. Note that it takes on the shape of the braided rope which
was used as the ligature and angles sharply upward to the point of suspension


Fig.43
Nylon dog leads are often used as ligatures in suicidal hangings

Fig.44

Removal of the lead in the case illustrated
in >Fig. 43 reveals a distinct weave
pattern marking the skin that corresponds
exactly to the weave of the ligature. The
ligature and parchmented weave pattern
around the neck should be photographed
together to document the concordance


Fig.45
A looped nylon rope around the neck in
a suicidal hanging


Fig.46
A typical parchmented mark underneath the
ligature in >Fig. 45


Fig.47
An obvious furrow mark caused by coaxial
cable in a suicidal hanging death


Fig.48
A less obvious furrow mark produced by a bed sheet (see
>Fig. 41)


Fig.49
Suicidal hanging differs from homicidal ligature
strangulation as the loop around the neck in suicide
rises to the point of suspension, as is very clearly
shown here


Fig.50
When the ligature is removed in a suicidal hanging, a ‘‘V’’ shaped furrow can usually be seen. In homicidal ligature strangulation, the
furrow from the ligature is more horizontal


Fig.51
Again a marked upward angle of the rope along the left side of this suicide victim’s neck and head


Fig.52
A ligature furrow mark on the posterior aspect of a suicidal hanging victim’s neck, with upward angulation (inverted ‘‘V’’ shape)


Fig.53
Knots in suicidal hanging may be very complex, as can be seen in this case in which an electric flex was used


Fig.54
A typical furrow may have a ‘‘tram track’’ appearance with central pallor and reddened edges


Fig.55
A double-looped ligature used in hanging will result in two underlying furrows


Fig.56
If a ligature slips during hanging, there may be two furrows. In the case illustrated, an alternative explanation for this injury pattern
would be a ligature homicide (producing the lower horizontal furrow) disguised as a suicidal hanging (producing the upper angled
furrow beneath the ear)


Fig.57
Tardieu spots on the leg of a hanging victim are produced by postmortem rupture of intensely congested small blood vessels


Fig.58
Fixed lividity with blanching on the sole of a hanging victim’s foot, indicating that the foot was in contact with the ground in
a low-suspension hanging


Fig.59
As the structures of the neck, including the tongue, are lifted upward during hanging, the tip of the tongue often protrudes from the
mouth and dries out, giving it a dark appearance


Fig.60
A strangulation death scene. Careful examination of the scene, the clothing, and the body may provide valuable evidence that could link
a perpetrator to the crime


Fig.61
Irregular ligature marks in a homicidal strangulation case


Fig.62
A case of ligature strangulation, viewed from the side. Note the lack of upward angulation of the mark which distinguishes it from the
usual ligature mark in suicidal hanging


Fig.63
A telephone line cord used as a ligature in a homicidal strangulation case has been left in place by the assailant


Fig.64
A homicidal ligature strangulation case in which a ‘‘zip-tie’’ was used as a ligature. Unlike most strangulation cases, the internal neck
examination in this case revealed no soft tissue hemorrhage


Fig.65
Extensive congestion of the skin with petechiae above the level of the ligature mark in a case of homicidal strangulation


Fig.66
A more subtle ligature furrow mark in a homicidal strangulation case, viewed from the back. Note that the mark is relatively horizontal
and lacks the upward angulation that is typical of hanging furrow marks


Fig.67
Symmetrical abrasions of the side of the neck in a case of manual strangulation


Fig.68
Injuries to the neck in homicidal manual strangulation deaths may be quite subtle


Fig.69
A close-up view of a fingernail scratch mark on the neck of the manual strangulation victim shown in >Fig. 68


Fig.70
Scratch marks around the neck from manual strangulation where the perpetrator was standing behind the victim


Fig.71
Postmortem ant activity may cause lesions on the neck that can be mistaken for strangulation marks


Fig.72
Anterior neck ‘‘strap’’ muscle hemorrhage in a strangulation case


Fig.73
Multiple, relatively small areas of anterior neck strap muscle hemorrhage in a homicidal strangulation case


Fig.74
Multiple fractures of the laryngeal cartilages (with surrounding soft tissue hemorrhage), related to a homicidal strangulation


Fig.75
A localized fracture of the right horn of the thyroid cartilage in a homicidal strangulation case (arrow)


Fig.76
A lateral hyoid bone fracture caused by neck pressure during strangulation. Note the hemorrhagic soft tissue surrounding the site of the
fracture (arrow), compared to the other side which was not injured


Fig.77
A fracture closer to the front of the hyoid bone in a case of ligature strangulation


Fig.78
Posterior neck hemorrhage demonstrated by postmortem dissection in a homicidal strangulation case


Fig.79
A scene photograph showing a woman who committed suicide by carbon monoxide/exhaust inhalation, a type of ‘‘chemical asphyxia,’’
as carbon monoxide binds to hemoglobin, preventing oxygenation of blood


Fig. 80
Interior view of the automobile used in the carbon monoxide suicide depicted in >Fig. 15.79 with the key in the ‘‘on’’ position


Fig.81
A scene photograph in a case of suicidal carbon monoxide inhalation in which the victim used a vacuum cleaner hose to blow
exhaust into the interior of a car (Photo courtesy of Dr. Patrick E. Lantz, MD, Department of Pathology, Wake Forest University School
of Medicine, Winston-Salem, NC)


Fig.82
Interior view of the case depicted in>Fig. 81 with a vacuum cleaner hose running from the exhaust to the cabin of the vehicle (Photo
courtesy of Dr. Patrick Lantz, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC)


Fig.83
A vacuum cleaner hose connected to an exhaust pipe in a case of suicide in a car from inhaling exhaust fumes (Photo courtesy of Dr.
Patrick Lantz, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC)


Fig.84
An elderly woman found dead in her bed.
The previous day, her furnace had been
professionally serviced. Toxicological
analyses showed that she had lethal levels
of carbon monoxide in her blood


Fig.85
Examination of the furnace (see
>Fig. 84) by an expert in the heating
business revealed that it was not venting
properly, resulting in carbon monoxide
release into the home


Fig.86
Comparison of the color of lividity in a natural death (left) with a death from carbon monoxide inhalation (right) showing the brighter
cherry red discoloration that occurs with carbon monoxide exposure (Photo courtesy of Dr. Patrick Lantz, MD Department of Pathology,
Wake Forest University School of Medicine, Winston-Salem, NC)


Fig.87
A container of cyanide used in a suicidal ingestion case (Courtesy of the Dallas County Medical Examiners Office, Jeffrey J. Barnard, Chief
Medical Examiner)


Fig.88
Gastric (stomach) mucosa hemorrhage in a case
of cyanide poisoning (Courtesy of the Dallas
County Medical Examiners Office, Jeffrey J.
Barnard, Chief Medical Examiner)


Fig.89
The brain of a man who died of hydrogen sulfide
gas inhalation (above) compared to a brain from
someone who died of natural causes (below)
revealing the characteristic green discoloration
from exposure to hydrogen sulfide (Courtesy of
the Dallas County Medical Examiners Office,
Jeffrey J. Barnard, Chief Medical Examiner)


Fig.90
Pornographic and other items found at the scene of
an autoerotic asphyxia death


Fig.91
An autoerotic asphyxia death where the victim
dressed in female clothing and loosely bound his
hands


Fig.92
Underclothing worn by the autoerotic
asphyxia victim depicted in >Fig. 91


Fig.93
A cable wrapped about the body of a victim
who died of accidental autoerotic asphyxia


. Fig.94
(a, b) An autoerotic asphyxial death in which the cross-dressed victim used duct tape, a variety of ligatures, and Freon gas


Fig.95
Female underclothing, ligatures, and
handcuffs are not infrequently found in cases
of autoerotic death


Fig.96
A closer view of the decedent’s legs in the
case from >Fig. 95 showing binding with
strips of panty hose and a set of cuffs


Fig.98
Restraint asphyxia death reenactment.
Notice that the victim is face-down, with
his hands cuffed behind his back, with
multiple police officers applying force to
his back


Fig.97
Ligature marks on the neck of a 9-year-old
boy found partially suspended from
a bandana looped about his neck, as
a result of the ‘‘choking game’’


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[Angelahh]

Awesome post! My fave subject

[laal]

One word, EPIC! Thanks!!!

[Faline]

Cool pictures and information GG

[02timmy]

Woooooooow.........

[kellyhound]

cool thread

the cross-dressed victim used duct tape, a variety of ligatures, and Freon gas

[durt]

nice pics, thanks!

[Bastet]

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[ropedoc]

Wow

[kayo brizzle]

Very informational, outstanding post.