Difference between revisions of "Forensic pathology"

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Forensic pathology (view source)

Revision as of 06:04, 10 May 2015

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→‎Environmental: split out
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==Environmental==
==Environmental==
Includes:
{{Main|Environmental causes of death}}
*Hypothermia.
*Hyperthermia.
*Drowning - see [[asphyxial deaths]].
*Lack of oxygen - see [[asphyxial deaths]].
*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=====
<gallery>
Image:Lightning_injury.jpg | Lichtenberg figure. (WC)
</gallery>
====Microscopic====
Features:
*Palisading of basal cells (like [[cautery artefact]]).


=Gunshot wounds=
=Gunshot wounds=
Michael
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