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Hypothermia

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Forensic Imaging of Trauma

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Abstract

The chapter discusses forensic investigation in hypothermia victims. Pathophysiology and epidemiology are presented, including frequent concomitant conditions like intoxication. Standard imaging procedures including radiography, computed tomography, as well as magnetic resonance imaging, ultrasound, and thermography are presented, as well as possible new research and investigation modalities are discussed. Classical findings in postmortem examination are presented, and radiological signs of hypothermia are critically reviewed, with special focus on computed tomography, as the most widely used modality. Special issues are discussed including high-altitude deaths, examination of avalanche victims, differential diagnosis between immersion hypothermia and drowning, as well as examination of frozen and decomposed bodies.

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References

  1. Madea B, Tsokos M, Preuss J. Death due to hypothermia. Morphological findings, their pathogenesis and diagnostic value. In: Tsokos M, editor. Forensic pathology reviews, vol. 5. Humana Press; 2008. p. 3–21.

    Chapter  Google Scholar 

  2. Palmiere C, Teresiński G, Hejna P. Postmortem diagnosis of hypothermia. Int J Legal Med. 2014;128(4):607–14.

    Article  PubMed  Google Scholar 

  3. Türk EE. Hypothermia. Forensic Sci Med Pathol. 2010;6:106–15.

    Article  PubMed  Google Scholar 

  4. Ulrich AS, Rathlev NK. Hypothermia and localized cold injuries. Emerg Med Clin North Am. 2004;22(2):281–98.

    Article  PubMed  Google Scholar 

  5. Lange S, Muggenthaler H, Hubig M, Mall G. The forensic relevance of hypothermia in living persons—literature and retrospective study. Forensic Sci Int. 2013;231(1-3):34–41.

    Article  CAS  PubMed  Google Scholar 

  6. Golden FS, Tipton MJ, Scott RC. Immersion, near-drowning and drowning. Br J Anaesth. 1997;79(2):214–25.

    Article  CAS  PubMed  Google Scholar 

  7. Witzmann FA. Temperature regulation and exercise physiology, the regulation of body temperature. In: Rhoades RA, Bell DR, editors. Medical physiology: principles for clinical medicine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 543–66.

    Google Scholar 

  8. Hall JE. Body temperature, temperature regulation, and fever. In: Guyton AC, Hall JE, editors. Textbook of medical physiology. 11th ed. Philadelphia: Elsevier; 2006. p. 889–901.

    Google Scholar 

  9. Teresiński G, Buszewicz G, Mądro R. Biochemical background of ethanol-induced cold susceptibility. Legal Med (Tokyo). 2005;7:15–23.

    Article  Google Scholar 

  10. Palmiere C, Bardy D, Letovanec I, Mangin P, Iglesias K, Augsburger M, Ventura F, Werner D. Biochemical markers of fatal hypothermia. Forensic Sci Int. 2013;226:54–61.

    Article  CAS  PubMed  Google Scholar 

  11. Hirvonen J. Necropsy findings in fatal hypothermia cases. Forensic Sci. 1976;8:155–64.

    Article  CAS  PubMed  Google Scholar 

  12. Hejna P, Zátopková L, Tsokos M. The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) in autopsy cases of fatal hypothermia. Int J Legal Med. 2012;126:415–9.

    Article  CAS  PubMed  Google Scholar 

  13. Bright F, Winskog C, Byard RW. Wischnewski spots and hypothermia: sensitive, specific, or serendipitous? Forensic Sci Med Pathol. 2013;9:88–90.

    Article  PubMed  Google Scholar 

  14. Preuss J, Lignitz E, Dettmeyer R, Madea B. Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int. 2007;166:194–8.

    Article  CAS  PubMed  Google Scholar 

  15. Ogata M, Ago K, Kondo T, Kasai K, Ishikawa T, Mikuzami H. A fatal case of hypothermia associated with hemorrhages of the pectoralis minor, intercostals, and iliopsoas muscles. Am J Forensic Med Pathol. 2007;28:348–52.

    Article  PubMed  Google Scholar 

  16. Nikolić S, Zivković V, Juković F, Babić D, Stanojkovski G. Simon’s bleedings: a possible mechanism of appearance and forensic importance—a prospective autopsy study. Int J Legal Med. 2009;123(4):293–7.

    Article  PubMed  Google Scholar 

  17. Kitzinger R, Risse M, Puschel K. Kälteidiotie Paradoxes Entkleiden bei Unterkühlung. Arch Kriminol. 1991;187:47–56.

    Google Scholar 

  18. Rothschild M. Lethal hypothermia: paradoxical undressing and hide-and-die-syndrome can produce very obscure death scenes. In: Tsokos M, editor. Forensic pathology reviews, vol. 1. Humana Press Inc.; 2004. p. 263–72.

    Chapter  Google Scholar 

  19. Wedin B, Vanggaard L, Hirvonen J. Paradoxical undressing in fatal hypothermia. J Forensic Sci. 1979;24:543–53.

    Article  CAS  PubMed  Google Scholar 

  20. Schäfer AT. Human primitive behavior. In: Tsokos M, editor. Forensic pathology reviews, vol. 2. Humana Press; 2005. p. 189–204.

    Chapter  Google Scholar 

  21. Grabherr S, Baumann P, Minoiu C, Fahrni S, Mangin P. Post-mortem imaging in forensic investigations: current utility, limitations, and ongoing developments. Res Rep Forensic Med Sci. 2016;6:25–37.

    Google Scholar 

  22. Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F. Modern post-mortem imaging: an update on recent developments. Forensic Sci Res. 2017;2(2):52–64.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chatzaraki V, Heimer J, Thali M, Dally A, Schweitzer W. Role of PMCT as a triage tool between external inspection and full autopsy—case series and review. J Forensic Radiol Imaging. 2018;15:26–38.

    Article  Google Scholar 

  24. Kawasumi Y, Onozuka N, Kakizaki A, Usui A, Hosokai Y, Sato M, Saito H, Ishibashi T, Hayashizaki Y, Funayama M. Hypothermic death: possibility of diagnosis by post-mortem computed tomography. Eur J Radiol. 2013;82:361–5.

    Article  PubMed  Google Scholar 

  25. Hyodoh H, Watanabe S, Katada R, Hyodoh K, Matsumoto H. Postmortem computed tomography lung findings in fatal of hypothermia. Forensic Sci Int. 2013;231:190–4.

    Article  PubMed  Google Scholar 

  26. Schweitzer W, Thali M, Giugni G, Winklhofer S. Postmortem pulmonary CT in hypothermia. Forensic Sci Med Pathol. 2014;10:557–69.

    Article  CAS  PubMed  Google Scholar 

  27. Fracasso T, Brinkmann B, Beike J, Pfeiffer H. Clotted blood as sign of alcohol intoxication: a retrospective study. Int J Legal Med. 2008;122:157–61.

    Article  CAS  PubMed  Google Scholar 

  28. Aghayev E, Thali MJ, Jackowski C, Sonnenschein M, Dirnhofer R, Yen K. MRI detects hemorrhages in the muscles of the back in hypothermia. Forensic Sci Int. 2008;176:183–6.

    Article  PubMed  Google Scholar 

  29. Teresiński G. Injuries of the thigh, knee, and ankle as reconstructive factors in road traffic accidents. In: Rich J, Dean DE, Powers RH, editors. Forensic medicine of the lower extremity. Forensic science and medicine. Totowa: Humana Press; 2005. p. 311–42.

    Chapter  Google Scholar 

  30. Mimasaka S, Oshima T, Ohtani M. Characterization of bruises using ultrasonography for potential application in diagnosis of child abuse. Legal Med (Tokyo). 2011;14(1):6–10.

    Article  Google Scholar 

  31. Charlier P, Chaillot PF, Watier L, Ménétrier M, Carlier R, Cavard S, Hervé C, de la Grandmaison GL, Huynh-Charlier I. Is post-mortem ultrasonography a useful tool for forensic purposes? Med Sci Law. 2013;53(4):227–34.

    Article  PubMed  Google Scholar 

  32. Fariña J, Millana C, Fdez-Aceñero MJ, Furió V, Aragoncillo P, Martín VG, Buencuerpo J. Ultrasonographical autopsy (echopsy): a new autopsy technique. Virchows Arch. 2002;440:635–9.

    Article  PubMed  Google Scholar 

  33. Sterzik V, Bohnert M. Reconstruction of crimes by infrared photography. Int J Legal Med. 2016;130(5):1379–85.

    Article  CAS  PubMed  Google Scholar 

  34. Oliver WR, Leone L. Digital UV/IR photography for tattoo evaluation in mummified remains. J Forensic Sci. 2012;57(4):1134–6.

    Article  PubMed  Google Scholar 

  35. Cullip M, Tran VC, Ball CG. Tattoo visualization using cross-polarized lighting and infrared photography. Forensic Sci Med Pathol. 2021;17(2):350–3.

    Article  CAS  PubMed  Google Scholar 

  36. Rost T, Kalberer N, Scheurer E. A user-friendly technical set-up for infrared photography of forensic findings. Forensic Sci Int. 2017;278:148–55.

    Article  PubMed  Google Scholar 

  37. Hourscht C, Christe A, Diers S, Thali MJ, Ruder TD. Learning from the living to diagnose the dead—parallels between CT findings after survived drowning and fatal drowning. Forensic Sci Med Pathol. 2019;15(2):249–51.

    Article  PubMed  Google Scholar 

  38. Lindholm P, Swenson ER, Martínez-Jiménez S, Guo HH. From ocean deep to mountain high: similar computed tomography findings in immersion and high-altitude pulmonary edema. Am J Respir Crit Care Med. 2018;198(8):1088–9.

    Article  PubMed  Google Scholar 

  39. Perich P, Tuchtan L, Bartoli C, Léonetti G, Piercecchi-Marti MD. Death from hypothermia during a training course under “extreme conditions”: related to two cases. J Forensic Sci. 2016;61(2):562–5.

    Article  PubMed  Google Scholar 

  40. Hackett PH, Luks AM, Lawley JS, Roach RC. High-altitude medicine and pathophysiology. In: Auerbach PS, Cushing TA, Harris NS, editors. Auerbach’s wilderness medicine. 7th ed. Philadelphia: Elsevier; 2017. p. 8–29.

    Google Scholar 

  41. Yanamandra U, Vardhan V, Saxena P, Singh P, Gupta A, Mulajkar D, Grewal R, Nair V. Radiographical spectrum of high-altitude pulmonary edema: a pictorial essay. Indian J Crit Care Med. 2021;25(6):668–74.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wilson MH, Newman S, Imray CH. The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009;8(2):175–91.

    Article  CAS  PubMed  Google Scholar 

  43. Grosse AB, Grosse CA, Steinbach LS, Zimmermann H, Anderson S. Imaging findings of avalanche victims. Skeletal Radiol. 2007;36(6):515–21.

    Article  PubMed  Google Scholar 

  44. Hohlrieder M, Brugger H, Schubert H, et al. Pattern and severity of injury in avalanche victims. High Alt Med Biol. 2007;8:56–61.

    Article  PubMed  Google Scholar 

  45. McIntosh SE, Grissom CK, Olivares CR, et al. Cause of death in avalanche fatalities. Wilderness Environ Med. 2007;18:293–7.

    Article  PubMed  Google Scholar 

  46. Stalsberg H, Albretsen C, Gilbert M, Kearney M, Moestue E, Nordrum I, Rostrup M, Orbo A. Mechanism of death in avalanche victims. Virchows Arch A Pathol Anat Histopathol. 1989;414(5):415–22.

    Article  CAS  PubMed  Google Scholar 

  47. Kobek M, Skowronek R, Jabłoński C, Jankowski Z, Pałasz A. Histopathological changes in lungs of the mountain snow avalanche victims and its potential usefulness in determination of cause and mechanism of death. Arch Med Sadowej Kryminol. 2016;66(1):23–31.

    PubMed  Google Scholar 

  48. Dolinak D, Matshes E, Lew E. Hypothermia. In: Forensic pathology. Principles and practice. 1st ed. San Diego: Elsevier Academic Press; 2008. p. 248–9.

    Google Scholar 

  49. Byard RW, Zhou C. Erosive gastritis, Armanni-Ebstein phenomenon and diabetic ketoacidosis. Forensic Sci Med Pathol. 2010;6:304–6.

    Article  PubMed  Google Scholar 

  50. Preuss J, Dettmeyer R, Lignitz E, Madea B. Fatty degeneration in renal tubule epithelium in accidental hypothermia victims. Forensic Sci Int. 2004;141:131–5.

    Article  CAS  PubMed  Google Scholar 

  51. Tsokos M, Rothschild MA, Madea B, Rie M, Sperhake JP. Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia. Am J Forensic Med Pathol. 2006;27(1):70–4.

    Article  PubMed  Google Scholar 

  52. Zhou C, Byard RW. Armanni-Ebstein phenomenon and hypothermia. Forensic Sci Int. 2011;206:82–4.

    Article  Google Scholar 

  53. Teresiński G, Buszewicz G, Mądro R. Acetonaemia as an initial criterion of evaluation of a probable cause of sudden death. Legal Med (Tokyo). 2009;11:18–24.

    Article  Google Scholar 

  54. Huttunen P. Effect of ethanol on the processes of thermoregulation. Acta Physiol Pol. 1990;41:25–31.

    CAS  PubMed  Google Scholar 

  55. Huttunen P, Hirvonen J. The effect of ethanol on the ability of Guinea-pigs to survive severe cold. Forensic Sci. 1977;9:185–93.

    Article  CAS  PubMed  Google Scholar 

  56. Kalant H, Le AD. Effects of ethanol on thermoregulation. Pharmacol Ther. 1983;23:313–64.

    Article  CAS  PubMed  Google Scholar 

  57. Andersen KL, Hellstrøm B, Lorentzen FV. Combined effect of cold and alcohol on heat balance in man. J Appl Physiol. 1963;18:975–82.

    Article  CAS  PubMed  Google Scholar 

  58. Teresiński G, Buszewicz G, Mądro R. The influence of ethanol on the level of ketone bodies in hypothermia. Forensic Sci Int. 2002;127:88–96.

    Article  PubMed  Google Scholar 

  59. Palmiere C, Mangin P. Postmortem biochemical investigations in hypothermia fatalities. Int J Legal Med. 2013;127:267–76.

    Article  PubMed  Google Scholar 

  60. Bańka K, Teresiński G, Buszewicz G. Free fatty acids as markers of death from hypothermia. Forensic Sci Int. 2014;234:79–85.

    Article  PubMed  Google Scholar 

  61. Bańka K, Teresiński G, Buszewicz G, Mądro R. Glucocorticosteroids as markers of death from hypothermia. Forensic Sci Int. 2013;229:60–5.

    Article  PubMed  Google Scholar 

  62. Palmiere C, Teresiński G, Hejna P, Mangin P, Grouzmann E. Diagnostic performance of urinary metanephrines for the postmortem diagnosis of hypothermia. Forensic Sci Med Pathol. 2014;10:518–25.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement

Tables and some of the figures have been used in textbook “Medycyna sądowa” [Forensic Medicine] ed. G. Teresiński, volumes 1–3, PZWL Medical Publishing House [in Polish]—with written permission from the Publisher.

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Authors and Affiliations

  1. Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland

    Grzegorz Teresiński

  2. Department of Radiology, Medical University of Lublin, Lublin, Poland

    Grzegorz Staśkiewicz

Authors
  1. Grzegorz Teresiński
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  2. Grzegorz Staśkiewicz
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Correspondence to Grzegorz Teresiński .

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Editors and Affiliations

  1. Geneva University Hospitals and University of Geneva, University Center of Legal Medicine Lausanne, Geneva, Vaud, Switzerland

    Silke Grabherr

  2. Diagnostic & Research Institute of Forensic Medicine, Medical University Graz, Graz, Austria

    Sarah Heinze

  3. Geneva University Hospitals and University of Geneva, University Center of Legal Medicine Lausanne-Geneva, Geneva, Geneve, Switzerland

    Tony Fracasso

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Teresiński, G., Staśkiewicz, G. (2024). Hypothermia. In: Grabherr, S., Heinze, S., Fracasso, T. (eds) Forensic Imaging of Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-48381-3_8

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  • DOI: https://doi.org/10.1007/978-3-031-48381-3_8

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