Pathological changes in the thyroid gland in crush asphyxia

The relationship between positional asphyxia and increasing body mass index

Review of the files of the Pathology section of Forensic Science SA over 17 yrs (January 2003-December 2019) revealed 32 adult cases of positional asphyxia (age range 18-87 years; average 49 years - m:f ratio 3:1). Predisposing/causative conditions were accidents, N = 8, alcohol intoxication N = 7, neurological disease N = 7, drug intoxication N = 5, morbid obesity N = 2, combinations of factors N = 2, and a single homicide N = 1. There was one case with below normal weight (BMI 17.9), with 6 cases having normal weights (BMI range 18.9-24.6, average 22.3), 9 being overweight (BMI range 25.3-29.5, average 27.9), and 16 being obese (BMI range 30-66.2, average 40.9). Only 7 cases (22%) had either under/normal weight compared to 25 (78%) who were overweight/obese (p < 0.05). Increasing body mass appears to be a risk factor to be considered in all forms of positional asphyxia; BMI should, therefore, be routinely taken into account in the forensic evaluation of such cases.

Crush asphyxia and ride-on lawn mowers

Search of files at Forensic Science SA, Australia, over the past 20 years (1997-2016) revealed three cases of death due to crush asphyxia associated with the use of ride-on lawn mowers. (1) A 61-year-old man was trapped under a ride-on mower that had rolled over. Autopsy examination revealed congestion and petechial haemorrhages of the face and chest, and markings on the chest associated with underlying rib fractures. (2) A 78-year-old man was trapped under a ride-on mower that had also rolled over. Autopsy examination revealed petechial haemorrhages of the face and chest and markings on the chest. (3) A 72-year-old man was found wedged between a ride-on mower and a tree, with petechial haemorrhages of the face and chest, and markings on the front and back of the chest. These cases demonstrate a rare cause of crush asphyxia, often in older males in the domestic environment, which may arise from more than one mechanism.

Histological Changes in the Thyroid Gland in Cases of Infant and Early Childhood Asphyxia-A Preliminary Study

A retrospective blinded study of thyroid gland histology was undertaken in 50 infants and young children aged from 1 to 24 months. Deaths were due to (i) suffocation (N = 7), hanging (4), wedging (3), and chest and/or neck compression (4), and (ii) SIDS (20), noncervical trauma (7), organic disease, (4) and drug toxicity (1). In the asphyxia group (N = 18), thyroid gland congestion ranged from 0 to 3+ with 39% of cases (7/18) having moderate/marked congestion. In three cases, focal aggregates of red blood cells (blood islands) were observed within the intrafollicular colloid. These deaths involved chest compression, chest and/or neck compression, and crush asphyxia in a vehicle accident, and all had facial petechiae. Only 22% of the 32 control cases (7/32) had moderate/marked congestion with no blood islands being identified (p < 0.05). Blood islands within the thyroid gland may be caused by congestion associated with crushing or compression and may provide supportive evidence for this diagnosis.

Traumatic asphyxia with diaphragmatic injury: a case report

Traumatic asphyxia, or Perthe's syndrome, is a rare clinical syndrome characterized by cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, neurological symptoms, and thoracic injury. It affects both adults and children after blunt chest traumas. The diagnosis of this condition is based mainly on the specific clinical signs, which should immediately bring to mind the severity of the trauma, the various probable types of pulmonary injuries, and the need for screening and careful assessment of other organs that might also be injured. In this report, we describe the case of a 39-year-old male who developed traumatic asphyxia after severe blunt chest trauma during his work at a construction site. The patient had multiple injuries to the chest, abdomen, head and neck, which were treated conservatively. An associated diaphragmatic injury was successfully treated by video-assisted thoracic surgery. This patient is one of five patients who were admitted to Saqr Hospital in the United Arab Emirates, diagnosed with traumatic asphyxia, and treated by mechanical ventilator, supportive measures, and fiberoptic bronchoscopy, for both diagnostic and therapeutic indications, in our unit in the period between July 2006 and June 2013. As traumatic asphyxia is a systemic injury, careful assessment of the patient and looking for other injuries is mandatory. Treatment usually involves supportive measures to the affected organs, but surgical intervention may sometimes prove to be an important part of the treatment. Bronchoscopy should be performed for diagnostic and therapeutic reasons because of the associated pulmonary and possible tracheobronchial injuries.