Difference between revisions of "Forensic pathology"

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Forensic pathology (view source)

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!Scenario
!Scenario
|-
|-
|[[Electrocution]]
| [[Electrocution]]
|accident
| accident
|cardiac arrhythmia
| [[cardiac arrhythmia]]
|man struck by lightening
| man struck by lightning
|-
|-
|Hyperthermia
| Hyperthermia
|accident
| accident
|arrhythmias, seizures<ref name=fmuk>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 19 April 2012.</ref>
| arrhythmias, seizures<ref name=fmuk>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 19 April 2012.</ref>
|man lost on hiking trip in desert
| man lost on hiking trip in desert
|-
|-
|[[Epidural hemorrhage]] due to [[blunt force trauma]] to the head
| [[Epidural hemorrhage]] due to [[blunt force trauma]] to the head
|homicide
| homicide
|brain stem compression or cerebral vascular spasm leading to autonomic dysregulation
| brain stem compression or cerebral vascular spasm leading to autonomic dysregulation
|man hit with a hammer in the head
| man hit with a hammer in the head
|-
|-
|[[Carbon monoxide toxicity]]
| [[Carbon monoxide toxicity]]
|suicide
| suicide
|cerebral hypoxia (CO binds to hemoglobin impairing oxygen transport)
| cerebral hypoxia (CO binds to hemoglobin impairing oxygen transport)
|woman found in car with suicide note, long history of depression
| woman found in car with suicide note, long history of depression, previous suicide attempts
|-
|-
|[[Atherosclerotic heart disease]]
| [[Atherosclerotic heart disease]]
|natural
| natural
|cardiac arrhythmia due to ischemia
| cardiac arrhythmia due to ischemia
|man has 95% stenosis of LMCA - no other significant autopsy findings
| man found dead in bed, apartment locked, 95% stenosis of LMCA at autopsy, no other significant autopsy findings
|- <!--
| [[Peritonitis]] due to duodenal perforation as a consequence of [[peptic ulcer disease]]
| natural
| cerebral hypoxia secondary to hypotension
| man found in locked apartment, complained of abdominal pain before dead
|-
| Coronary artery stent thrombosis complicating the treatment of a [[myocardial infarction]] due to atherosclerotic heart disease
| natural
| cardiac arrhythmia due to ischemia
| woman found dead following hospital stay for a myocardial infarction, post-angioplasty and coronary stenting -->
|}
|}


==Manner of death==
==Manner of death==
The manner of death is a legislatively defined classification. It varies slightly between jurisdictions.
<!--
<!--
MANNER OF DEATH
MANNER OF DEATH
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==Cause of death==
==Cause of death==
*Abbreviated ''COD''.
===General===
===General===
*The cause of death should be what started the sequence of events that lead to death.
*The cause of death should be what started the sequence of events that lead to death.


===="Word form"====
====Word form for cause of death====
Example:
Examples:
*''[[C. difficile colitis]] complicating antibiotic treatment for a dental abscess''.<ref>MSP. 8 September 2010.</ref>
*''[[C. difficile colitis]] complicating antibiotic treatment for a dental abscess''.<ref>MSP. 8 September 2010.</ref>
*''Complications of laparoscopic cholecystectomy for ascending cholangitis with [[mesothelioma]] and atherosclerotic heart disease''.<ref>TR. 3 September 2010.</ref>
*''Complications of laparoscopic cholecystectomy for ascending cholangitis with [[mesothelioma]] and atherosclerotic heart disease''.<ref>TR. 3 September 2010.</ref>
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*''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''.
*''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''.


====WHO form====
====World Health Organization form for cause of death====
General form:<ref name=pmid15914304>{{cite journal |author=Pollanen MS |title=Deciding the cause of death after autopsy--revisited |journal=J Clin Forensic Med |volume=12 |issue=3 |pages=113–21 |year=2005 |month=June |pmid=15914304 |doi=10.1016/j.jcfm.2005.02.004 |url=}}</ref>
General form:<ref name=pmid15914304>{{cite journal |author=Pollanen MS |title=Deciding the cause of death after autopsy--revisited |journal=J Clin Forensic Med |volume=12 |issue=3 |pages=113–21 |year=2005 |month=June |pmid=15914304 |doi=10.1016/j.jcfm.2005.02.004 |url=}}</ref>
*1a = immediate cause of death.
*1a = ''immediate cause of death''.
*1b = what lead to the immediate cause of death.
*1b = what lead to the ''immediate cause of death''.
*1c... 1[x] -- where 'x' is the last letter used; 1x = What started the sequence of events.
*1c... 1[x] -- where 'x' is the last letter used; 1x = What started the sequence of events. This is known as the ''underlying cause of death''.
*2 = contributing factors.
*2 = contributing factors.


Example 1:
Example 1:
*1a. Ketoacidosis.
*1a. [[Ketoacidosis]].
*1b. Diabetes mellitus.
*1b. [[Diabetes mellitus]].
*1c. Alcoholism.
*2. [[Alcoholism]] and acute [[bronchopneumonia]].
*2.  Acute bronchopneumonia.


Example 2:
Example 2:
*1a. Hemoperitoneum.
*1a. Hemoperitoneum.
*1b. Splenic laceration.
*1b. [[Splenic laceration]].
*1c. Blunt force trauma.
*1c. Blunt force trauma.
*2. Liver [[cirrhosis]].
*2. Liver [[cirrhosis]].


===Natural deaths===
===Natural deaths===
{{Main|Natural death}}
*The cause should be a medical diagnosis, '''not''' the mechanism (e.g. ''cardiac arrest'', ''cachexia'', ''kidney failure'').
*The cause should be a medical diagnosis, '''not''' the mechanism (e.g. ''cardiac arrest'', ''cachexia'', ''kidney failure'').
*The mechanism is irrelevant.
*The [[mechanism of death|mechanism]] is irrelevant.


Notes:
Notes:
*Unnatural causes trump natural ones.  If a guy with (nothing more than) a 70% proximal LAD stenosis and an old [[myocardial infarct]] is found in the water, they are usually called drowning.
*Unnatural causes trump natural ones.  If a guy with (nothing more than) a 70% proximal LAD stenosis and an old [[myocardial infarct]] is found in the water, they are usually called [[drowning]].
*Cancer is rarely the immediate cause of death - it is usually something else.<ref>PS. 2009.</ref>
*[[Cancer]] is rarely the immediate cause of death - it is usually something else.<ref>Shannon, P. 2009.</ref>
*Things (mechanisms) that shouldn't be used: [http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html]
*Things (mechanisms) that shouldn't be used: [http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html]


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====General====
====General====
*In Ontario, the ''manner'' is determined by the coroner.
*In Ontario, the ''manner'' is determined by the coroner.
*Coroners, in Ontario, are MDs -- usually family docs.
*Coroners, in Ontario, are MDs -- usually [[family docs]].
*The cause (e.g. "gunshot wound to the head") is determined by the pathologist.
*The cause (e.g. "gunshot wound to the head") is determined by the pathologist.


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**Haemorrhage (e.g. cerebral bleed, gastrointestinal bleed, aortic aneurysm).
**Haemorrhage (e.g. cerebral bleed, gastrointestinal bleed, aortic aneurysm).
**Infection (e.g. [[pneumonia]]).
**Infection (e.g. [[pneumonia]]).
**Coronary [[atherosclerosis]] (cardiac arrhythmias - more common in the forensic context than myocardial infarction (MI); individuals with MIs don't usu. drop dead-- they go to the ER).
**[[Coronary artery atherosclerosis]] ([[cardiac arrhythmia]]s - more common in the forensic context than [[myocardial infarction]] (MI); individuals with MIs don't usu. drop dead-- they go to the ER).
***Post [[myocardial infarction]] (free wall rupture).
***Post [[myocardial infarction]] (free wall rupture).
***Ruptured (atherosclerotic) plaque.
***Ruptured (atherosclerotic) plaque.
*Toxic (memory device: ''PAIRO''):
*Toxic (memory device: ''PAIRO''):
**Poisons.
**Poisons.
**Alcohol (EtOH).  
**[[Alcohol]] (EtOH).  
**Illicit (e.g. [[cocaine]], heroin, LSD).  
**Illicit (e.g. [[cocaine]], heroin, LSD).  
**Rx.  
**Rx.  
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=Wounds=
=Wounds=
==General==
==General==
*Definition: defect in skin or mucous membrane<ref>URL: [http://dictionary.reference.com/browse/wound http://dictionary.reference.com/browse/wound]. Accessed on: 20 April 2012.</ref> - usually due to trauma.
*''Wound'' - definition: defect in skin or mucous membrane<ref>URL: [http://dictionary.reference.com/browse/wound http://dictionary.reference.com/browse/wound]. Accessed on: 20 April 2012.</ref> - usually due to trauma.


Special types of wounds:
Special types of wounds:
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*Incised wounds - see [[sharp force trauma]].
*Incised wounds - see [[sharp force trauma]].


===Gross pathologic classification of wounds===
===Gross pathologic classification of injuries===
Mnemonic ''CALI'':
Mnemonic ''CALI'':
*'''C'''ontusion - "bruise", haematoma.
*'''C'''ontusion - "bruise", [[hematoma]].
**Age (usual colour change sequence): red, blue, green, yellow, brown.<ref name=Ref_HospAuto108>{{Ref HospAuto|108}}</ref>
**Age (usual colour change sequence): red, blue, green, yellow, brown.<ref name=Ref_HospAuto108>{{Ref HospAuto|108}}</ref>
**Etiology: bleeding from arterioles or venules (not capillaries).<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref>
**Etiology: bleeding from arterioles or venules (not capillaries).<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref>
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*#"Chop" = typically have a contusion at the margin of the wound, classically caused by an axe. May be caused by a propeller.<ref name=pmid19733336>{{Cite journal  | last1 = Ihama | first1 = Y. | last2 = Ninomiya | first2 = K. | last3 = Noguchi | first3 = M. | last4 = Fuke | first4 = C. | last5 = Miyazaki | first5 = T. | title = Fatal propeller injuries: three autopsy case reports. | journal = J Forensic Leg Med | volume = 16 | issue = 7 | pages = 420-3 | month = Oct | year = 2009 | doi = 10.1016/j.jflm.2009.04.006 | PMID = 19733336 }}</ref>
*#"Chop" = typically have a contusion at the margin of the wound, classically caused by an axe. May be caused by a propeller.<ref name=pmid19733336>{{Cite journal  | last1 = Ihama | first1 = Y. | last2 = Ninomiya | first2 = K. | last3 = Noguchi | first3 = M. | last4 = Fuke | first4 = C. | last5 = Miyazaki | first5 = T. | title = Fatal propeller injuries: three autopsy case reports. | journal = J Forensic Leg Med | volume = 16 | issue = 7 | pages = 420-3 | month = Oct | year = 2009 | doi = 10.1016/j.jflm.2009.04.006 | PMID = 19733336 }}</ref>


====Images====
<gallery>
Image:Hand_Abrasion_-_32_minutes_after_injury.JPG | Abrasion. (WC)
Image:Black_eye_2.jpg | Contusion ("black eye"). (WC)
</gallery>
====DDx====
====DDx====
How to decide what you're looking at:
How to decide what you're looking at:
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=Bone fractures=
=Bone fractures=
*[[AKA]] ''fractures''.
*[[AKA]] ''fractures''.
*[[AKA]] ''fracture of bone''.
==Artefactual fractures==
==Artefactual fractures==
*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>
*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>
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Features:
Features:
*Fragmentation of bone.
*Fragmentation of bone.
*+/-Dead bone = lacunae have no osteocytes.
*+/-Dead bone = lacunae have no osteocytes.<ref name=pmid22460748>{{Cite journal  | last1 = Fondi | first1 = C. | last2 = Franchi | first2 = A. | title = Definition of bone necrosis by the pathologist. | journal = Clin Cases Miner Bone Metab | volume = 4 | issue = 1 | pages = 21-6 | month = Jan | year = 2007 | doi =  | PMID = 22460748 }}</ref>
**Takes days for osteocyte loss.
*+/-Inflammatory cells.
*+/-Inflammatory cells.
*+/-Hemosiderin-laden macrophages.
*+/-Hemosiderin-laden macrophages.
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*Complete hinge fractures are considered severe; they are a 4 on the ''abbreviated injury scale'' (AIS).<ref>{{Cite journal  | last1 = Adams | first1 = VI. | last2 = Carrubba | first2 = C. | title = The Abbreviated Injury Scale: application to autopsy data. | journal = Am J Forensic Med Pathol | volume = 19 | issue = 3 | pages = 246-51 | month = Sep | year = 1998 | doi =  | PMID = 9760090 }}</ref>
*Complete hinge fractures are considered severe; they are a 4 on the ''abbreviated injury scale'' (AIS).<ref>{{Cite journal  | last1 = Adams | first1 = VI. | last2 = Carrubba | first2 = C. | title = The Abbreviated Injury Scale: application to autopsy data. | journal = Am J Forensic Med Pathol | volume = 19 | issue = 3 | pages = 246-51 | month = Sep | year = 1998 | doi =  | PMID = 9760090 }}</ref>
*Classically due to a blow to the chin - resulting in a fracture across the medial fossa and sella turcica.<ref>URL: [http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving]. Accessed on: 28 March 2012.</ref>
*Classically due to a blow to the chin - resulting in a fracture across the medial fossa and sella turcica.<ref>URL: [http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving]. Accessed on: 28 March 2012.</ref>
===Pathologic fracture===
{{Main|Pathologic fracture}}
*A fracture due to an underlying pathology.
===Hip fractures===
*[[Traumatic fracture of the femoral neck]].


=Autopsy=
=Autopsy=
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==Environmental==
==Environmental==
Includes:  
{{Main|Environmental causes of death}}
*Hypothermia.  
They include:  
*Hyperthermia.  
*[[Hypothermia]].  
*[[Hyperthermia]].  
*Drowning - see [[asphyxial deaths]].
*Drowning - see [[asphyxial deaths]].
*Lack of oxygen - see [[asphyxial deaths]].  
*Lack of oxygen - see [[asphyxial deaths]].  
*Electrocution.
*[[Electrocution]].
 
===Hypothermia===
Features:<ref name=>{{cite journal |author=E. E. Türk, J. P. Sperhake, K. Pueschel and Michael Tsokos |title=An approach to the evaluation of fatal hypothermia |journal=Forensic Science, Medicine, and Pathology |volume=1 |issue=1 |pages=31–35 |year=2005 |month= |pmid= |doi= |url=http://www.springerlink.com/content/n785314u75m71j8h/fulltext.pdf}}</ref>
*Reddening of exposed skin areas "frost erythema" - '''classic feature'''.
*Wischnewski spots ([[AKA]] Leopard spots) - '''classic feature'''.
**Brown/black spots of the gastric mucosa ~ 0.1-0.4 cm; thought to represent pre-mortem/perimortem hemorrhage.<ref>{{cite journal |author=Tsokos M, Rothschild MA, Madea B, Rie M, Sperhake JP |title=Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia |journal=Am J Forensic Med Pathol |volume=27 |issue=1 |pages=70–4 |year=2006 |month=March |pmid=16501354 |doi=10.1097/01.paf.0000202716.06378.91 |url=http://journals.lww.com/amjforensicmedicine/Abstract/2006/03000/Histological_and_Immunohistochemical_Study_of.14.aspx}}</ref>
*Paradoxical undressing; decedent has removed clothes due to perception of being too hot.<ref name=pmid20151230>{{cite journal |author=Turk EE |title=Hypothermia |journal=Forensic Sci Med Pathol |volume=6 |issue=2 |pages=106–15 |year=2010 |month=June |pmid=20151230 |doi=10.1007/s12024-010-9142-4 |url=}}</ref>
 
Notes:
*Findings are often non-specific.<ref name=pmid16948514>{{cite journal |author=Nixdorf-Miller A, Hunsaker DM, Hunsaker JC |title=Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=9 |pages=1297–304 |year=2006 |month=September |pmid=16948514 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B1297%3AHAHMIO%5D2.0.CO%3B2}}</ref>
*Non-specific findings seen in hypothermia:<ref name=pmid16948514/>
**[[Pulmonary edema]].
**Hemorrhagic pancreatitis.
**Hemorrhage of the iliopsoas muscle.
*DDx of reddening of skin includes [[Carbon_monoxide toxicity|carbon monoxide poisoning]].
Image:
*[http://www.springerlink.com/content/n785314u75m71j8h/fulltext.pdf Wischnewski spots (springerlink.com)].
 
===Hyperthermia===
Features:
*Findings are non-specific.<ref name=pmid16948514>{{cite journal |author=Nixdorf-Miller A, Hunsaker DM, Hunsaker JC |title=Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=9 |pages=1297–304 |year=2006 |month=September |pmid=16948514 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B1297%3AHAHMIO%5D2.0.CO%3B2}}</ref>
*Short survival:
**+/-Petechiae - serosal (pleural, epicardial, pericardial) and cerebral periventricular.
**+/-Cerebral edema.
*Long survival:
**Findings consistent with hypovolemic shock (hepatic [[necrosis]], cerebral edema, [[DAD]] in lung, acute [[pancreatitis]]).
**Clinical/biochemical: [[rhabdomyolysis]], [[DIC]], [[ATN]].
 
===Electrocution===
====General====
*May be missed - as can be subtle.
*Usually causes death by cardiac arrhythmia.
*Typically accidents.<ref>{{Cite journal  | last1 = Wick | first1 = R. | last2 = Gilbert | first2 = JD. | last3 = Simpson | first3 = E. | last4 = Byard | first4 = RW. | title = Fatal electrocution in adults--a 30-year study. | journal = Med Sci Law | volume = 46 | issue = 2 | pages = 166-72 | month = Apr | year = 2006 | doi =  | PMID = 16683472 }}</ref>
*Occasionally used to suicide.<ref name=pmid19298463>{{Cite journal  | last1 = Dokov | first1 = W. | title = Forensic characteristics of suicide by electrocution in Bulgaria. | journal = J Forensic Sci | volume = 54 | issue = 3 | pages = 669-71 | month = May | year = 2009 | doi = 10.1111/j.1556-4029.2009.01002.x | PMID = 19298463 }}</ref>
 
====Gross features====
*Usually burns on the hands - brown.
**Typically absent if it happened in a wet environment.<ref name=pmid12062943>{{Cite journal  | last1 = Karger | first1 = B. | last2 = Süggeler | first2 = O. | last3 = Brinkmann | first3 = B. | title = Electrocution--autopsy study with emphasis on electrical petechiae. | journal = Forensic Sci Int | volume = 126 | issue = 3 | pages = 210-3 | month = May | year = 2002 | doi =  | PMID = 12062943 }}</ref>
*Focal injury suggestive of high voltage (> 1000 V).
*Lichtenberg figure = fern-like figure.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Rear_view_of_a_lightning-strike_survivor,_displaying_Lichtenberg_figure_on_skin.png Lichtenberg figure (WC)].
 
====Microscopic====
Features:
*Palisading of basal cells (like cautery artefact).


=Gunshot wounds=
=Gunshot wounds=
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Features:<ref name=pmid11334832>{{cite journal |author=Kohl P, Nesbitt AD, Cooper PJ, Lei M |title=Sudden cardiac death by Commotio cordis: role of mechano-electric feedback |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=280–9 |year=2001 |month=May |pmid=11334832 |doi= |url=}}</ref><ref>{{cite journal |author=Maron BJ, Estes NA |title=Commotio cordis |journal=N. Engl. J. Med. |volume=362 |issue=10 |pages=917–27 |year=2010 |month=March |pmid=20220186 |doi=10.1056/NEJMra0910111 |url=http://www.nejm.org/doi/full/10.1056/NEJMra0910111}}</ref>
Features:<ref name=pmid11334832>{{cite journal |author=Kohl P, Nesbitt AD, Cooper PJ, Lei M |title=Sudden cardiac death by Commotio cordis: role of mechano-electric feedback |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=280–9 |year=2001 |month=May |pmid=11334832 |doi= |url=}}</ref><ref>{{cite journal |author=Maron BJ, Estes NA |title=Commotio cordis |journal=N. Engl. J. Med. |volume=362 |issue=10 |pages=917–27 |year=2010 |month=March |pmid=20220186 |doi=10.1056/NEJMra0910111 |url=http://www.nejm.org/doi/full/10.1056/NEJMra0910111}}</ref>
*Often negative autopsy; no cardiac pathology.
*Often negative autopsy; no cardiac pathology.
*Etiology: arrhythmia.
*Etiology: [[cardiac arrhythmia|arrhythmia]].
*History: trauma to chest.
*History: trauma to chest.


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==Scenarios==
==Scenarios==
===Motor vehicle collisions===
===Motor vehicle collisions===
*Pedestrian vs. motor vehicle: heel to injury measurement.<ref>{{Ref OPMfP|18}}</ref>
*Pedestrian vs. motor vehicle: heel to injury measurement, remember to include the thickness of the heel/sole of shoe.<ref>{{Ref OPMfP|18}}</ref>
*Dicing injuries: tempered glass used in side window construction fragments into cubes when fractured causing L-shaped wounds.


===Descent from height===
===Descent from height===
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*Bite marks, as evidence, have a limited value for identification purposes.
*Bite marks, as evidence, have a limited value for identification purposes.
**In the context of identifying a potential perpetrator, it is essential to swab the bite mark for saliva, which is rich in DNA.<ref>{{Cite journal  | last1 = Pretty | first1 = IA. | title = Forensic dentistry: 2. Bitemarks and bite injuries. | journal = Dent Update | volume = 35 | issue = 1 | pages = 48-50, 53-4, 57-8 passim | month =  | year =  | doi =  | PMID = 18277695 }}</ref>
**In the context of identifying a potential perpetrator, it is essential to swab the bite mark for saliva, which is rich in DNA.<ref>{{Cite journal  | last1 = Pretty | first1 = IA. | title = Forensic dentistry: 2. Bitemarks and bite injuries. | journal = Dent Update | volume = 35 | issue = 1 | pages = 48-50, 53-4, 57-8 passim | month =  | year =  | doi =  | PMID = 18277695 }}</ref>
====Images====
<gallery>
Image: Dog_bite.JPG | Bite injury. (WC)
</gallery>


===Aortic trauma===
===Aortic trauma===
*Classic location of injury is subclavian branch point.<ref name=pmid1934437>{{cite journal |author=Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF |title=Traumatic rupture of the thoracic aorta. A 20-year review: 1969-1989 |journal=Circulation |volume=84 |issue=5 Suppl |pages=III40–6 |year=1991 |month=November |pmid=1934437 |doi= |url=}}</ref>
*Classic location of transection of the aorta is distal the the left subclavian branch point near the insertion of the ligamentum arteriosum (e.g. peri-isthmus).<ref name=pmid1934437>{{cite journal |author=Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF |title=Traumatic rupture of the thoracic aorta. A 20-year review: 1969-1989 |journal=Circulation |volume=84 |issue=5 Suppl |pages=III40–6 |year=1991 |month=November |pmid=1934437 |doi= |url=}}</ref>
*[[Aortic dissection]] due to trauma is often catastrophic.
*[[Aortic dissection]] due to trauma is often catastrophic. Several mechanisms have been proposed and there is a body of trauma biomechanics research that explores this.


==Trauma with delayed death==
==Trauma with delayed death==
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**"Clean" edge (no contusion, no abrasion).
**"Clean" edge (no contusion, no abrasion).
**Well-demarcated edges.
**Well-demarcated edges.
*+/-Hilt mark.
**Due to contact of hilt.


Subclassified into - see ''[[Wounds|classification of wounds]]'':
Subclassified into - see ''[[Wounds|classification of wounds]]'':
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*''Stab''.  
*''Stab''.  
*''Chop'' - a mixed injury, sharp force and blunt force.
*''Chop'' - a mixed injury, sharp force and blunt force.
====Images====
<gallery>
Image: Thorax-Messerstichwunden.jpg | Sharp force trauma - thorax. (WC)
</gallery>


=Head injuries=
=Head injuries=
Line 639: Line 633:


===Stains===
===Stains===
*[[Beilschowsky stain]] to highlight axonal swellings - appear 12-18 hours after injury.<ref name=Ref_Shkrum_562>{{Ref Shkrum|562}}</ref>
*[[Bielschowsky stain]] to highlight axonal swellings - appear 12-18 hours after injury.<ref name=Ref_Shkrum_562>{{Ref Shkrum|562}}</ref>
 
===IHC===
===IHC===
*Beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref><ref name=pmid17368446>{{Cite journal  | last1 = Mac Donald | first1 = CL. | last2 = Dikranian | first2 = K. | last3 = Song | first3 = SK. | last4 = Bayly | first4 = PV. | last5 = Holtzman | first5 = DM. | last6 = Brody | first6 = DL. | title = Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. | journal = Exp Neurol | volume = 205 | issue = 1 | pages = 116-31 | month = May | year = 2007 | doi = 10.1016/j.expneurol.2007.01.035 | PMID = 17368446 | PMC = 1995439 }}</ref>
*Beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref><ref name=pmid17368446>{{Cite journal  | last1 = Mac Donald | first1 = CL. | last2 = Dikranian | first2 = K. | last3 = Song | first3 = SK. | last4 = Bayly | first4 = PV. | last5 = Holtzman | first5 = DM. | last6 = Brody | first6 = DL. | title = Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. | journal = Exp Neurol | volume = 205 | issue = 1 | pages = 116-31 | month = May | year = 2007 | doi = 10.1016/j.expneurol.2007.01.035 | PMID = 17368446 | PMC = 1995439 }}</ref>
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===Toxins===
===Toxins===
====Ethanol toxicity====
====Ethanol toxicity====
{{Main|Ethanol abuse}}
*Usually measured (in Canada) as: ''mass of EtOH (mg)/volume of blood (mL)''.
*Usually measured (in Canada) as: ''mass of EtOH (mg)/volume of blood (mL)''.
**Limit (Ontario): 80 milligrams of alcohol in 100 millilitres of blood (0.08 gm/100 mL).<ref>URL: [http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml]. Accessed on: 28 September 2010.</ref>
**Limit (Ontario): 80 milligrams of alcohol in 100 millilitres of blood (0.08 gm/100 mL).<ref>URL: [http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml]. Accessed on: 28 September 2010.</ref>
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:For a more general discussion see ''[[Crystals_in_body_fluids#Urine_crystals|urine crystals]]''
:For a more general discussion see ''[[Crystals_in_body_fluids#Urine_crystals|urine crystals]]''
*Not done in routine toxicology screening.
*Not done in routine toxicology screening.
*Birefringent calcium oxalate crystals found in kidney (with polarized light).<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>
*Birefringent calcium oxalate crystals found in kidney (with [[polarized light]]).<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>


====Anaphylaxis====
====Anaphylaxis====
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Generally, these things are:
Generally, these things are:
*Cardiovascular:
*Cardiovascular:
**Arrhythmia.
**[[Cardiac arrhythmia|Arrhythmia]].
**Myocardial infarction.
**[[Myocardial infarction]].
**Haemorrhage.
**Haemorrhage.
***Ruptured aneurysm.
***Ruptured aneurysm.
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*GI:
*GI:
**Haemorrhage.
**Haemorrhage.
***Esophageal varices.
***[[Esophageal varices]].
***Gastric varices.
***Gastric varices.
*Neurologic:
*Neurologic:
**Intracranial haemorrhage.
**Intracranial haemorrhage.
***Ruptured aneurysm.
***Ruptured aneurysm.
***Spontaneous subdural haemorrhage.
***Spontaneous [[subdural hemorrhage]].
**Stroke:
**[[Stroke]]:
***Haemorrhagic.
***Haemorrhagic.
***Thrombotic (more common than haemorrhagic).
***Thrombotic (more common than hemorrhagic).


=Forensic entomology=
=Forensic entomology=
Michael
48,448

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