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Thoracic trauma in fatal falls from height — Traumatic pneumopericardium correlates with height of fall and severe injury

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Abstract

Pneumopericardium (PPC) describes the collection of gas in the pericardial sac. In tension Pneumopericardium (tPPC), this collection of gas may lead to cardiac tamponade. PPC following blunt trauma is considered a rare finding, as reflected by the low number of case reports on the topic. We analyzed the prevalence and pathophysiology of PPC and the associated trauma in 44 cases of falls from height. We retrospectively analyzed postmortem CT data and autopsy reports of fatal falls in the period March 2014–2017. A valid estimation of the height of the fall and a documented impact on an even and hard surface were inclusion criteria. A total of 44 cases were included in the study. We identified PPC in 18 of the 44 cases, and it was associated with an increased height of the fall, alongside aortic, pericardial, and myocardial ruptures. All cases with PPC also presented with bilateral pneumothorax. Five cases presented with a “ballooning” pericardium, indicating tPPC. PPC is a common finding in cases of falls from great heights. Due to a significant correlation with height and thus impact severity, PPC may be used as a reconstructive element in medico-legal investigations. Association with trauma makes PPC a sign of severe thoracic injury in postmortem and clinical radiology.

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Acknowledgments

The authors are grateful to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland

    Jakob Heimer, Dominic Gascho, Michael J. Thali & Wolf Schweitzer

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  1. Jakob Heimer
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  2. Dominic Gascho
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  3. Michael J. Thali
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  4. Wolf Schweitzer
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Correspondence to Jakob Heimer.

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This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval was obtained by the Ethics Committee of the Canton of Zurich, Nr. KEK ZH-Nr. 15–0686.

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Heimer, J., Gascho, D., Thali, M.J. et al. Thoracic trauma in fatal falls from height — Traumatic pneumopericardium correlates with height of fall and severe injury. Forensic Sci Med Pathol 14, 188–193 (2018). https://doi.org/10.1007/s12024-018-9977-7

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  • DOI: https://doi.org/10.1007/s12024-018-9977-7

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