Advertisement

International Journal of Legal Medicine

, Volume 131, Issue 5, pp 1423–1428 | Cite as

Hypothermia provokes hemorrhaging in various core muscle groups: how many of them could we have missed?

  • Lenka Zátopková
  • Petr Hejna
  • Cristian Palmiere
  • Grzegorz Teresiński
  • Martin Janík
Original Article

Abstract

The postmortem diagnosis of hypothermia remains problematic even in the era of molecular and digital diagnostic advances. Gross hemorrhages in iliopsoas muscles have been regarded as a helpful diagnostic sign in hypothermia fatalities; nevertheless, they have received marginal attention since their original description. The present study attempts to fill that void by examining occurrence, localization, and diagnostic significance of the bleeding into the core muscles as evidence of death due to hypothermia in a series comprising 51 consecutive hypothermia autopsy cases. Hemorrhages into the core muscles were identified in 33 cases of fatal hypothermia (65%). Hemorrhages were present in iliopsoas muscles (19 cases; 37%), deep back muscles (18 cases; 35%), and in other core muscular groups such as the diaphragm, cervical, pectoral, and intercostal muscles (11 cases; 22%). The results of the study offer an attractive diagnostic opportunity and reaffirm the potential of the careful core muscle dissection for the clarification of hypothermic deaths. Centers lacking high-end imaging technologies and molecular postmortem programs may especially benefit, which may have implications in broader autopsy practice.

Keywords

Fatal hypothermia Core muscle Hemorrhage Autopsy Postmortem diagnosis Forensic pathology 

Supplementary material

414_2017_1596_MOESM1_ESM.pdf (87 kb)
Scheme 1 The entanglement of pathogenetic linkages leading to muscular hemorrhages in hypothermia fatalities (supplementary material) (PDF 87 kb)

References

  1. 1.
    Palmiere C, Teresiński G, Hejna P (2014) Postmortem diagnosis of hypothermia. Int J Legal Med 128:607–614CrossRefPubMedGoogle Scholar
  2. 2.
    Palmiere C, Mangin P (2013) Postmortem biochemical investigations in hypothermia fatalities. Int J Legal Med 127:267–276CrossRefPubMedGoogle Scholar
  3. 3.
    Palmiere C, Bardy D, Letovanec I, Mangin P, Augsburger M, Ventura F, Iglesias K, Werner D (2013) Biochemical markers of fatal hypothermia. Forensic Sci Int 226:54–61CrossRefPubMedGoogle Scholar
  4. 4.
    Bańka K, Teresiński G, Buszewicz G (2014) Free fatty acids as markers of death from hypothermia. Forensic Sci Int 234:79–85CrossRefPubMedGoogle Scholar
  5. 5.
    Hervet T, Teresiński G, Hejna P, Descloux E, Grouzmann E, Palmiere C (2016) Catecholamines and their O-methylated metabolites in vitreous humor in hypothermia cases. Forensic Sci Med Pathol 12:163–169CrossRefPubMedGoogle Scholar
  6. 6.
    Aghayev E, Thali MJ, Jackowski C, Sonnenschein M, Dirnhofer R, Yen K (2008) MRI detects hemorrhages in the muscles of the back in hypothermia. Forensic Sci Int 176:183–186CrossRefPubMedGoogle Scholar
  7. 7.
    Schweitzer W, Thali M, Giugni G, Winklhofer S (2014) Postmortem pulmonary CT in hypothermia. Forensic Sci Med Pathol 10:557–569CrossRefPubMedGoogle Scholar
  8. 8.
    Hyodoh H, Watanabe S, Katada R, Hyodoh K, Matsumoto H (2013) Postmortem computed tomography lung findings in fatal of hypothermia. Forensic Sci Int 231:190–194CrossRefPubMedGoogle Scholar
  9. 9.
    Wang Q, Ishikawa T, Michiue T, Zhu BL, Guan DW, Maeda H (2013) Molecular pathology of pulmonary edema in forensic autopsy cases with special regard to fatal hyperthermia and hypothermia. Forensic Sci Int 228:137–141CrossRefPubMedGoogle Scholar
  10. 10.
    Chen JH, Michiue T, Ishikawa T, Maeda H (2012) Molecular pathology of natriuretic peptides in the myocardium with special regard to fatal intoxication, hypothermia, and hyperthermia. Int J Legal Med 126:747–756CrossRefPubMedGoogle Scholar
  11. 11.
    Türk EE (2010) Hypothermia. Forensic Sci Med Pathol 6:106–115CrossRefPubMedGoogle Scholar
  12. 12.
    Bright F, Winskog C, Byard RW (2013) Wischnewski spots and hypothermia: sensitive, specific, or serendipitous? Forensic Sci Med Pathol 9:88–90CrossRefPubMedGoogle Scholar
  13. 13.
    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 3–21CrossRefGoogle Scholar
  14. 14.
    Schneider V, Klug E (1980) Death by hypothermia. Are there any new diagnostic aspects? Z Rechtsmed 86:59–69CrossRefPubMedGoogle Scholar
  15. 15.
    Wessel J, Schneider V (1987) Increased occurrence of deaths due to hypothermia caused by surprise cold fronts. Lebensversicher Med 39:58–61PubMedGoogle Scholar
  16. 16.
    Hottmar P, Hejna P (2005) Death due to fatal hypothermia in victims dissected in Department of Forensic Medicine in Hradec Králové between 1992–2003. Soud Lek 50:38–41PubMedGoogle Scholar
  17. 17.
    Ogata M, Ago K, Kondo T, Kasai K, Ishikawa T, Mikuzami H (2007) A fatal case of hypothermia associated with hemorrhages of the pectoralis minor, intercostal, and iliopsoas muscles. Am J Forensic Med Pathol 28:348–352CrossRefPubMedGoogle Scholar
  18. 18.
    Brinkmann B (1999) Harmonization of medico-legal autopsy rules. Committee of Ministers. Council of Europe. Int J Legal Med 113:1–14CrossRefPubMedGoogle Scholar
  19. 19.
    Hejna P, Zátopková L (2012) Significance of hemorrhages at the origin of the sternocleidomastoid muscles in hanging. Am J Forensic Med Pathol 33:124–127CrossRefPubMedGoogle Scholar
  20. 20.
    Püschel K, Schulz F, Darrmann I, Tsokos M (1999) Macromorphology and histology of intramuscular hemorrhages in cases of drowning. Int J Legal Med 112:101–106CrossRefPubMedGoogle Scholar
  21. 21.
    Sigrist T, Markwalder C, Dirnhofer R (1990) Changes in skeletal muscles in death caused by hypothermia. Z Rechtsmed 103:463–472CrossRefPubMedGoogle Scholar
  22. 22.
    von Hofmann E (1893) Textbook of forensic medicine. Urban & Schwarzenberg, Wien, Leipzig, pp 605–607Google Scholar
  23. 23.
    Dirnhofer R, Sigrist T (1979) Muscle hemorrhages in the body core: a sign of a vital reaction in death from hypothermia? Beitr Gerichtl Med 37:159–166PubMedGoogle Scholar
  24. 24.
    Rohrer MJ, Natale AM (1992) Effects of hypothermia on the coagulation cascade. Crit Care Med 20:1402–1405CrossRefPubMedGoogle Scholar
  25. 25.
    Polderman KH (2012) Hypothermia and coagulation. Crit Care 16:A20CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Byard RW (2013) The changing face of the ‘royal disease’—medicolegal aspects of haemophilia. J Forensic Legal Med 20:392–394CrossRefGoogle Scholar
  27. 27.
    Rubin R, Strayer DS, Rubin E (2011) Rubin’s pathology: clinicopathological foundations of medicine, 6th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Lenka Zátopková
    • 1
  • Petr Hejna
    • 1
  • Cristian Palmiere
    • 2
  • Grzegorz Teresiński
    • 3
  • Martin Janík
    • 4
  1. 1.Department of Forensic MedicineCharles University, Faculty of Medicine and University Hospital Hradec KrálovéHradec KrálovéCzech Republic
  2. 2.CURMLLausanne 25Switzerland
  3. 3.Chair and Department of Forensic MedicineMedical University of LublinLublinPoland
  4. 4.Institute of Legal Medicine and Medico-legal Expertise, Jessenius Faculty of MedicineComenius UniversityMartinSlovakia

Personalised recommendations