Advertisement

International Journal of Legal Medicine

, Volume 126, Issue 3, pp 415–419 | Cite as

The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) in autopsy cases of fatal hypothermia

  • P. HejnaEmail author
  • L. Zátopková
  • M. Tsokos
Original Article

Abstract

We describe and discuss autopsy findings of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) within a study population comprising 36 cases of fatal hypothermia and 300 control cases. Synovial membrane hemorrhage and bloody discoloration of synovial fluid of the knees were seen in 27 cases of fatal hypothermia (75%). Though we are not dealing here with an obligatory autopsy finding in fatal hypothermia, the detection of the inner knee sign might be used as another corroborative sign of vital hypothermia after considering all differential diagnostic aspects. However, the absence of this finding does not exclude death due to hypothermia.

Keywords

Synovial membrane hemorrhage Synovial fluid hemorrhage Inner knee sign Vital signs Hypothermia Autopsy 

References

  1. 1.
    Türk EE (2010) Hypothermia. Forensic Sci Med Pathol 6:106–115PubMedCrossRefGoogle Scholar
  2. 2.
    Madea B, Preuß J, Lignitz E (2004) Unterkühlung: Umstände, Morphologische Befunde und ihre Pathogenese. Rechtsmedizin 14:41–59CrossRefGoogle Scholar
  3. 3.
    Madea B, Preuß J, Henn V, Lignitz E (2004) Morphological findings in fatal hypothermia and their pathogenesis. In: Oehmichen M (ed) Hypothermia—clinical, pathomorphological and forensic features. Schmidt-Römhild, Lübeck, pp 181–204Google Scholar
  4. 4.
    Lignitz E (2007) Kälte. In: Madea B (ed) Praxis Rechtsmedizin. Springer, Berlin, pp 185–190Google Scholar
  5. 5.
    Madea B, Tsokos M, Preuß J (2008) Death due to hypothermia—morphological findings, their pathogenesis and diagnostic value. In: Tsokos M (ed) Forensic pathology reviews, vol 5. Humana Press, Totowa, pp 3–21Google Scholar
  6. 6.
    Dettmeyer R (2011) Forensic histopathology. Springer, Berlin, pp 165–171CrossRefGoogle Scholar
  7. 7.
    Dirnhofer R, Sigrist T (1979) Muskelblutungen in Körperkern – ein Zeichen vitaler Reaktion bei Tod durch Unterkühlung? Beitr Gerichtl Med 37:159–166PubMedGoogle Scholar
  8. 8.
    Richter M (1905) Gerichtsärtzliche Diagnostik und Technik. Hirzel, LeipzigGoogle Scholar
  9. 9.
    Preuß J, Dettmeyer R, Lignitz E, Madea B (2007) Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int 166:194–198PubMedCrossRefGoogle Scholar
  10. 10.
    Simon A, Müller E (1971) Einige Aspekte zur Physiologie und Morphologie des Kältetodes unter besonderer Berücksichtigung der sogenannten Kälteschilddrüse. Kriminal Forens Wiss 6:131–138Google Scholar
  11. 11.
    Büchner F (1943) Die Pathologie der Unterkühlung. Klin Wschr 22:89–92CrossRefGoogle Scholar
  12. 12.
    Ishikawa T, Miyaishi S, Tachibana T, Ishizu H, Zhu BL, Maeda H (2004) Fatal hypothermia related vacuolization of hormone-producing cells in the anterior pituitary. Legal Med (Tokyo) 6:157–163CrossRefGoogle Scholar
  13. 13.
    Doberentz E, Preuß-Wössner J, Kuchelmeister K, Madea B (2011) Histological examination of the pituitary glands in cases of fatal hypothermia. Forensic Sci Int 207:46–49PubMedCrossRefGoogle Scholar
  14. 14.
    Lignitz E, Henn V (2007) New autopsy signs in violent death. Forensic Sci Int 165:172–177PubMedCrossRefGoogle Scholar
  15. 15.
    Yoshida C, Ishikawa T, Michiue T, Quan L, Maeda H (2011) Postmortem biochemistry and immunohistochemistry of chromogranin A as a stress marker with special regard to fatal hypothermia and hyperthermia. Int J Legal Med 125:11–20PubMedCrossRefGoogle Scholar
  16. 16.
    Palmiere C, Mangin P (2011) Postmortem chemistry update part I. Int J Legal Med. doi: 10.1007/s00414-011-0625-y
  17. 17.
    DiMaio VJ, DiMaio D (2001) Forensic pathology. CRC Press, Boca Raton, pp 428–432Google Scholar
  18. 18.
    Saukko P, Knight B (2004) Knight’s forensic pathology, 3rd edn. Arnold, London, pp 414–420Google Scholar
  19. 19.
    Dolinak D, Matshes EW, Lew EO (2005) Forensic pathology. Principles and practice. Elsevier Academic Press, London, pp 248–250Google Scholar
  20. 20.
    Perper JA Microscopic forensic pathology. In: Spitz WU (ed) Spitz and Fisher’s medicolegal investigation of death. Charles C Thomas, Springfield, p 1117Google Scholar
  21. 21.
    Weinke H (1996) Ein neues Zeichen beim Unterkühlungstod. 5. Frühjahrstagung der Deutschen Gesellschaft für Rechtsmedizin – Region Nord. Rostock, 10./11.05.1996Google Scholar
  22. 22.
    Grobe N, Philipp K, Weinke H, Gibb B (1982) Befunde beim Tod durch Unterkühlung. 9. Regionaltagung Nord der Gesellschaft für Gerichtliche Medizin der DDR. Bad SaarowGoogle Scholar
  23. 23.
    Mengel A (2009) Kältebedingte innere Kniegelenkbefunde beim Unterkühlungstod unter Berücksichtigung anderer kälteassoziierter pathomorphologischer Befunde. MD thesis. GreifswaldGoogle Scholar
  24. 24.
    Türk EE, Sperhake JP, Madea B, Preuß J, Tsokos M (2006) Immunohistochemical detection of hemoglobin in frost erythema. Forensic Sci Int 10:131–134CrossRefGoogle Scholar
  25. 25.
    Nikolić S, Zivković V, Juković F, Babić D, Stanojkovski G (2009) Simon’s bleedings: a possible mechanism of appearance and forensic importance—a prospective autopsy study. Int J Legal Med 123:293–297PubMedCrossRefGoogle Scholar
  26. 26.
    Schulz F, Schäfer H, Püschel K, Tsokos M, Brinkmann B, Buschmann CT (2011) Bowel wall hemorrhage after death by hanging. Int J Legal Med 125:403–410PubMedCrossRefGoogle Scholar
  27. 27.
    Schulz F, Buschmann C, Braun C, Püschel K, Brinkmann B, Tsokos M (2011) Haemorrhages into the back and auxiliary breathing muscles after death by hanging. Int J Legal Med 125:863–871PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Institute of Legal Medicine, Faculty of Medicine in Hradec KrálovéCharles University in PragueHradec KrálovéCzech Republic
  2. 2.Institute of Legal Medicine and Forensic Sciences, CharitéUniversity Medicine BerlinBerlinGermany

Personalised recommendations