Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT

An unusual case of corpse concealment driven by emotional distress

Corpse concealment involves hiding a body for criminal purposes for many different reasons, such as destroy evidence of a murder or avoid the discovery of the victim. Although defendants could argue that they did not conceal the corpse with any criminal intent, but rather to spare themselves or others from emotional distress or to honor the wishes of the deceased. However, these arguments are often challenging to substantiate, and defendants may encounter significant legal obstacles when attempting to justify their actions. Herein, we report a case involving the concealment of a woman's corpse by her father. Autopsy and histological investigations were significantly limited due to the advanced decomposition of the body. Nevertheless, by integrating these data with radiological findings obtained from total body CT and micro-CT of the larynx-hyoid complex, hanging was deemed the cause of death. Additionally, the psychological evaluation of the father indicated that the act of concealment was motivated by emotions rather than criminal intent.

Pathological Findings in Hanging: Is the Traditional Knowledge Correct?

BACKGROUND

In forensic pathology, asphyxia presents a problem as frequently as it is thorny and challenging. Some knowledge in forensic pathology is still considered to be traditionally acquired and is not critically assessed with modern statistical or technical tools. In this study, we seek to examine the injuries that are considered to be typical of cases of hanging (neck lesions, haemorrhages, and pleural and epicardial petechiae).

METHODS

We evaluated whether there was, indeed, a statistically significant association between these injuries and deaths from hanging as compared to non-hanging deaths. We collected 399 cases (32 deaths by hanging and 367 cases of non-hangings), built contingency tables and performed chi-square tests for each variable (lesion) examined; we also analysed this association in various subgroups of the sample (according to sex, age and weight ranges).

RESULTS

Our results did not deviate from the expected outcome based on traditional knowledge, although they do provide a more detailed demonstration and clarification of traditional knowledge regarding this topic.

CONCLUSIONS

These findings provide valuable insights for future discussion, examination and deepening of knowledge that is traditionally accepted but often undersupported in the literature.

Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings

Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen’s Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.

Cervical intervertebral separation caused by trauma on post-mortem computed tomography: Possibility of a diagnosis based on intervertebral gas

OBJECTIVES

Gas is a common finding in cervical intervertebral separation. However, intervertebral gas is also found in many decedents without intervertebral separation. Here, we quantified intervertebral gas and examined its value in the diagnosis of cervical intervertebral separation.

METHODS

We retrospectively reviewed data from 1118 decedents who underwent post-mortem computed tomography (CT) and autopsy from May 2011 to July 2016 and selected those with cervical intervertebral gas with or without intervertebral separation. These data comprised 56 cervical intervertebral spaces with gas [intervertebral separation in 19 (33.9%)] in 43 subjects [intervertebral separation in 17 (39.5%)]. We categorised the decedents according to gas volume, position, and shape and determined the significance of the differences between the decedents with and without separation.

RESULTS

The gas volume did not differ significantly between decedents with and without separation (p = 0.063). However, there were significant differences in the gas position between decedents with and without separation. In the sagittal plane: gas was seen in the "centred" position in the ventral-to-dorsal direction in more decedents without separation than in those with separation (p = 0.018). Gas was seen in the ventral-to-dorsal positions in more decedents with separation than in those without separation (p = 0.049). In the cranio-caudal direction, gas in the upper position was more common in decedents with separation than in those without separation in the sagittal plane (p = 0.03). In the coronal plane: gas was seen in the upper position more frequently in decedents with separation in the cranio-caudal direction than in those without separation (p = 0.001). A significant difference in gas shape was observed only in the coronal plane (p = 0.024); irregular gas was associated with decedents without separation.

CONCLUSION

Gas in the ventral-to-dorsal and upper positions in the sagittal plane and in the upper position in the coronal plane was rather indicative of cervical intervertebral separation. An irregular gas shape in the coronal plane was indicative of degenerative changes.

Simon's sign: Case report and review of the literature

Hanging is a common method of suicide and multiple autopsy findings can be observed at the postmortem examination. Simon's sign is a haemorrhage into the anterior aspect of the intervertebral discs of the lumbar region that can be observed in hangings and other traumatic causes of death. This finding is considered evidence of vitality. Several mechanisms have been proposed regarding bleeding development. In this paper, we present a case of hanging in which Simon's sign was observed at the autopsy. A review of the literature regarding Simon's bleeding has been performed, and a discussion of the potential mechanism is reported. Although Simon's sign may be observed in hangings, a careful evaluation of all the available data, including investigation, autopsy findings, and toxicology, is mandatory to avoid misinterpretation of death's cause and manner.