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Difference between revisions of "Forensic pathology"
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→Death categorization: fix word 'lightning'
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| accident | | accident | ||
| [[cardiac arrhythmia]] | | [[cardiac arrhythmia]] | ||
| man struck by | | man struck by lightning | ||
|- | |- | ||
| Hyperthermia | | Hyperthermia | ||
| Line 77: | Line 77: | ||
*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 for cause of death==== | ||
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> | ||
| Line 86: | Line 86: | ||
*''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''. | *''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''. | ||
==== | ====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''. | ||
| Line 94: | Line 94: | ||
Example 1: | Example 1: | ||
*1a. Ketoacidosis. | *1a. [[Ketoacidosis]]. | ||
*1b. Diabetes mellitus. | *1b. [[Diabetes mellitus]]. | ||
* | *2. [[Alcoholism]] and 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]]. | ||
| Line 252: | Line 251: | ||
=Wounds= | =Wounds= | ||
==General== | ==General== | ||
* | *''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: | ||
| Line 258: | Line 257: | ||
*Incised wounds - see [[sharp force trauma]]. | *Incised wounds - see [[sharp force trauma]]. | ||
===Gross pathologic classification of | ===Gross pathologic classification of injuries=== | ||
Mnemonic ''CALI'': | Mnemonic ''CALI'': | ||
*'''C'''ontusion - "bruise", | *'''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: | ||
| Line 331: | Line 335: | ||
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. | ||
| Line 442: | Line 447: | ||
==Environmental== | ==Environmental== | ||
{{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]]. | ||
=Gunshot wounds= | =Gunshot wounds= | ||
| Line 541: | Line 500: | ||
==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 | *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= | ||
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===Stains=== | ===Stains=== | ||
*[[ | *[[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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: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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*Cardiovascular: | *Cardiovascular: | ||
**[[Cardiac arrhythmia|Arrhythmia]]. | **[[Cardiac arrhythmia|Arrhythmia]]. | ||
**Myocardial infarction. | **[[Myocardial infarction]]. | ||
**Haemorrhage. | **Haemorrhage. | ||
***Ruptured aneurysm. | ***Ruptured aneurysm. | ||
| Line 887: | Line 860: | ||
*GI: | *GI: | ||
**Haemorrhage. | **Haemorrhage. | ||
***Esophageal varices. | ***[[Esophageal varices]]. | ||
***Gastric varices. | ***Gastric varices. | ||
*Neurologic: | *Neurologic: | ||
**Intracranial haemorrhage. | **Intracranial haemorrhage. | ||
***Ruptured aneurysm. | ***Ruptured aneurysm. | ||
***Spontaneous subdural | ***Spontaneous [[subdural hemorrhage]]. | ||
**Stroke: | **[[Stroke]]: | ||
***Haemorrhagic. | ***Haemorrhagic. | ||
***Thrombotic (more common than | ***Thrombotic (more common than hemorrhagic). | ||
=Forensic entomology= | =Forensic entomology= | ||