Forensic Science, Medicine and Pathology

, Volume 15, Issue 4, pp 642–645 | Cite as

Positional asphyxia in a work-related fatality

  • Lucia TattoliEmail author
  • Niccolò Dino Melloni
  • Giancarlo Di Vella
Images in Forensics


Positional or postural asphyxia occurs when a particular body position interferes with adequate respiratory movements for a lengthy period of time. Death is usually accidental and associated with alcohol or drug intoxication, disability, or restraint. We report on the case of a 42-year-old man found unresponsive while working on farmland. The upper part of his body (head and upper limbs) was trapped in the highest and largest opening of the atomizer of a high-volume sprayer tank while his legs were hanging down. Bruises and abrasions were found on both suprascapular regions. Tramline bruises encircled the body between the abdominal and thoracic regions in line with the morphology of the tank’s opening where the body was found. Cyanosis and petechial hemorrhages were found on his face, conjunctives, neck, and superior chest; the lungs were edematous. Toxicological analyses of body fluids were negative. The cause of death was postural asphyxia, and the manner of death was certified as a fatal accident at work. Work-related postural asphyxia has rarely been described in the literature. Scene investigation, autopsy, and toxicological analyses play a key role in the reconstruction of the dynamics involved in occupational events, in turn allowing the identification of any legal responsibilities of the worker or the employer.


Positional asphyxia Work-related fatality Accident Scene investigation 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals undertaken by any of the authors.


  1. 1.
    Benomran FA, Hassan AI. An unusual accidental death from positional asphyxia. Am J Forensic Med Pathol. 2011;32:31–4.CrossRefGoogle Scholar
  2. 2.
    Fernando T, Byard RW. Positional asphyxia without active restraint following an assault. J Forensic Sci. 2013;58:1633–5.CrossRefGoogle Scholar
  3. 3.
    Chaudhari VA, Ghodake DG, Kharat RD. Positional asphyxia: death due to unusual head-down position in a narrow space. Am J Forensic Med Pathol. 2016;37:51–3.CrossRefGoogle Scholar
  4. 4.
    Sauvageau A, Boghossian E. Classification of asphyxia: the need for standardization. J Forensic Sci. 2010;55:1259–67.CrossRefGoogle Scholar
  5. 5.
    Hayashi T, Buschmann C, Correns A, Herre S, Tsokos M. Fatal positional asphyxia. Forensic Sci Med Pathol. 2012;8:470–2.CrossRefGoogle Scholar
  6. 6.
    O'Halloran RL, Frank JG. Asphyxial death during prone restraint revisited: a report of 21 cases. Am J Forensic Med Pathol. 2000;21:39–52.CrossRefGoogle Scholar
  7. 7.
    Byard RW, Wick R, Gilbert JD. Conditions and circumstances predisposing to death from positional asphyxia in adults. J Forensic Legal Med. 2008;15:415–9.CrossRefGoogle Scholar
  8. 8.
    Sauvageau A, Desjarlais A, Racette S. Deaths in a head-down position: a case report and review of the literature. Forensic Sci Med Pathol. 2008;4:51–4.CrossRefGoogle Scholar
  9. 9.
    Benomran FA. Fatal accidental asphyxia in a jack-knife position. J Forensic Legal Med. 2010;17:397–400.CrossRefGoogle Scholar
  10. 10.
    DiMaio VJ, DiMaio D. Asphyxia. In: Geberth VJ, editor. Forensic pathology. Boca Raton: CRC Press; 2001. p. 229–77.Google Scholar
  11. 11.
    Saukko P, Knight B. Suffocation and ‘asphyxia’. In: Saukko P, Knight B, editors. Knight’s forensic pathology. Boca Raton: CRC Press; 2016. p. 353–66.Google Scholar
  12. 12.
    Solarino B, Leonardi S, Grattagliano I, Tattoli L, Di Vella G. An unusual death of a masochist: accident or suicide? Forensic Sci Int. 2011;204:e16–9.CrossRefGoogle Scholar
  13. 13.
    Wankhede AG, Dongre AP. Head injury with traumatic and postural asphyxia: a case report. Med Sci Law. 2002;42:358–9.CrossRefGoogle Scholar
  14. 14.
    Cappelletti S, Cipolloni L, Piacentino D, Aromatario M. A lethal case of hoarding due to the combination of traumatic and confined space asphyxia. Forensic Sci Med Pathol. 2019;15:114–8.CrossRefGoogle Scholar
  15. 15.
    Boghossian E, Tambuscio S, Sauvageau A. Nonchemical suffocation deaths in forensic setting: a 6-year retrospective study of environmental suffocation, smothering, choking, and traumatic/positional asphyxia. J Forensic Sci. 2010;55:646–51.CrossRefGoogle Scholar
  16. 16.
    Byard RW, Tsokos M. Infant and early childhood asphyxial deaths diagnostic issues. In: Tsokos M, editor. Forensic pathology reviews, vol. 2. Totowa: Humana Press; 2005. p. 101–23.CrossRefGoogle Scholar
  17. 17.
    Bell MD, Rao CV, Wetli CV, Rodriguez RN. Positional asphyxiation in adults. A series of 30 cases from the Dade and Broward County Florida Medical Examiner Offices from 1982 to 1990. 1992;13:101–7.Google Scholar
  18. 18.
    Padosch SA, Schmidt PH, Kröner LU, Madea B. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations. Forensic Sci Int. 2005;149:67–73.CrossRefGoogle Scholar
  19. 19.
    Suruda AJ. Work-related deaths in construction painting. Scand J Work Environ Health. 1992;18:30–3.CrossRefGoogle Scholar
  20. 20.
    Chmieliauskas S, Mundinas E, Fomin D, Andriuskeviciute G, Laima S, Jurolaic E, et al. Sudden deaths from positional asphyxia: a case report. Medicine (Baltimore). 2018;97:e11041.CrossRefGoogle Scholar
  21. 21.
    Fersini F, Govi A, Tsokos M, Etzold S, Tattoli L. Examples of tramline bruises in clinical forensic medicine. Forensic Sci Med Pathol. 2017;13:508–10.CrossRefGoogle Scholar
  22. 22.
    Tattoli L, Tsokos M, Buschmann C. Internal patterned injuries in trauma. Forensic Sci Med Pathol. 2018;14:123–6.CrossRefGoogle Scholar
  23. 23.
    Haan JM, Hauschild D, Patterson C, Ward JG, Helmer SD. Fatal agricultural accidents in Kansas: a thirty-one-year study. Am Surg. 2018;84:581–6.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.S.C. Medicina Legale UA.O.U. Città della Salute e della Scienza di TorinoTorinoItaly
  2. 2.Department of Public Health and Pediatrics, Section of Legal MedicineUniversity of TurinTorinoItaly

Personalised recommendations