Unveiling the Mysteries: Exploring Postmortem Artefacts in Forensic Medicine

DEFINITION

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Postmortem Artefacts is any change caused or feature introduced in a body after death (accidental or physiologically unrelated finding to the natural state of the body), that is likely to lead to misinterpretation of medico-legally significant ante-mortem findings. 

 

M/L Importance of Postmortem Artefacts:

Often the doctor is the chief source of evidence upon which legal decisions are made. The decision of acquittal or imprisonment completely depends on his evidence. Therefore, the doctor should learn to draw conclusions logically and correctly, instead of forming hasty judgment.

 

Types of Postmortem Artefacts-

Before death

During Death

Between death & autopsy

During autopsy

BEFORE DEATH

 

—  Death due to convulsive disorder

—  Bruising

—  Rupture of muscles

—  Subconjunctival hemorrhage

—  Joint dislocation

—  Tongue, lips bite

 

—  Death due to hemorrhagic diathesis

—  Petechial hemorrhage

—  Bleeding in joint space

—  Bleeding in other potential spaces- pleural, peritoneal

 

—  Death due to respiratory distress

—  Cyanosis

—  Salivation

—  Petechiae

 

—  Death due to ICP

—  Flattening of gyri

—  Edematous

—  Herniation of unci

 

—  Death due to burn

—  Heat ruptures may resemble lacerated ro incised wounds.

—  Heat haematoma may simulate extradural haemorrhaege

 

—  Miscellaneous

—  Post-mortem injuries produced from the bumping of the body into rocks, coral or marine structures should be distinguished from ante-mortem trauma.

—  Similarly, fractures caused by fall into the water from a height due to the body striking forcibly against some solid object, or mutilation from  boat propellears, or loss of fingers, toes, eyelids, lips, genitals or rarely whole portions of the body occuring from the attacks of marine animals should also be distinguished

DURING DEATH

AGONAL ARTEFACTS:  

—  Regurgitation and aspiration of gastric contents is a common agonal artefact. It may be seen in natural deaths, as a terminal event, or due to handling of the body, or due to resuscitation.

—  One of the effects of asphyxia is to cause vomiting due to medullary suboxia.

—  Oesophagogastromalacia is rarely seen in persons who die within hours or days after receiving severe head injury with cerebral damage. This occurs due to autodigestion; stomach contents are spilled into left chest cavity or left subphrenic area.

—  Signs from muscle spasm if occurred (bruise, abrasion, sub conjunctival hemorrhage etc.

—  Signs of asphyxia if respiratory distress occurred from any cause such as petechae, cyanosis etc.

 

II. RESUSCITATION ARTEFACTS:

—  The injection marks of resuscitation are usually found in the cardiac region or on the extremities. In intracardiac injection, heart may show contusion and blood may collect in the pericardium.

—  A defibrillatorapplied to the chest may produce a ring-like contusion. 

—  External massage may cause bruising of the anterior chest wall, hemorrhage into subcutaneous tissues and pectoral muscles, fracture of several ribs and sometimes of sternum.

—  Vigorous resuscitation with a thoracotomy and internal cardiac massage, produces air embolism. When positive pressure breathing apparatus (respirator) is used for resuscitation, it produces acute emphysema, sometimes with subpleural blebs, air in the mediastinum or tension pneumothorax

—  Contusions of soft tissues of the neck may be mistaken for homicidal strangulation.

—  These resuscitation injuries may be mistaken for those due to assault or from steering-wheel impact injuries.

—  Damage to the mouth, palate, pharynx and larynx can occur from attempts to introduce a laryngoscope.

—  Mouth-to-mouth breathing may cause contusions of the face, neck, and damage to the lips and inner gums, when the face and neck have been gripped by a hand.

BETWEEN DEATH AND AUTOPSY

 

—  Artefacts due to the handling of the body:

—  Occasionally, fractures of the ribs or the bones of extremities, or of cervical spine may occur by rough handling of bodies, especially if there is severe osteoporosis

—  Contusion of the occipital region may be caused, if the head of corpse is allowed to fall on a hard surface during handling.

—  Fresh abrasions may be produced due to dragging of the body which were originally free from them, during the transfer of the body from the scene of crime. 

—  Undertaker’s fracture is a subluxation of the lower cervical spine due to tearing of the intervertebral disc at about C6-C7.

 

—  Atrefacts Related to Rigor Mortis:

—  The handling of the body may cause breaking of the rigor at least partially, which may mislead the doctor in the estimation of the time of death

—  The onset and duration of the rigor may be altered by atmospheric conditions like extreme heat or cold, or ante-mortem conditions like muscular state, exhaustion, wasting diseases, and hyperthermia due to infections.

—  Rigor affecting the heart may simulate concentric hypertrophy of the heart. 

—  Rigor mortis may accentuate the rugae or fix a point of contraction so as to give a pseudo-hourglass, which is readily removed by traction.

—   Rigor in pylorus causes it to be unduly firm and contracted

 

—  Artefacts Related to Post-mortem Lividity:  

—  The color of the post mortem stains is usually bluish-purple. Certain poisons may change the

—  color of the hypostatic area, e.g., cherry-red color in CO poisoning, bright-red color in HCN poisoning, brown or chocolate color in poisoning by nitrites, potassium chlorate and aniline, dark-brown color in phosphorus poisoning.

—  Patches of hemorrhage, sometimes quit large and confluent, can occur in the tissues behind the esophagus at the level of the larynx.

—  ‘Banding’ of the esophagus may be seen, especially when the tissues are congested

 

—  Artefacts due to Decomposition:

—  Intense localized lividity of skin due to hypostasis, or displacement of internal pools of blood by pressure of gases of decomposition produces pseudo-bruising which may simulate ante-mortem bruises.  

—  Internal hypostasis with hemolysis of red cells may resemble hemorrhage, especially in the meninges, kidneys and retroperitoneal tissues.

—  In a dead body lying on its back, blood accumulates in the posterior part of the scalp due to gravity

—  Bloody fluid may be found in the mouth and nose in decomposed bodies, which is marked in conditions which produce pulmonary edema. 

—  Accumulation of blood in the tissues of the neck in drowning may simulate ante-mortem hemorrhage due to strangulation. 

—  The blood becomes darker in decomposition, due to which the brain, lungs, heart, etc, appear congested, which may be mistaken for signs of asphyxia

 

—  Artefacts due to Animal and Insect Bites:

—   Rodents gnaw away tissue over localised areas. They produce shallow craters with irregular borders by nibbling and leave long grooves.

—  The bites by dogs are clear-cut, with deep impressions of teeth in small area.

—  Cat bites are usually very small and round.

—  Marks produced by insects (ants or roaches) are dry, brown with irregular margins, and are usually seen in moist parts of the body, e.g., ears, armpits, groins, scrotum, anus, etc.

—   Rarely injuries, caused by crabs, may simulate stab wounds.

—  Aquatic animals may cause same types of artefacts in dead body situated in water.

 

—  Post-mortem Hemorrhage: 

—  Before the blood clots, a post-mortem injury may damage a blood vessel and produce hemorrhage. 

—  After death, blood may collect in the pleural cavities due to wounds produced on the chest wall and the lung tissue.

—  After death, blunt impact may lacerate blood vessels and displace red cells into the tissue spaces.

 

—  Artefacts due to Chemicals:

—  In automobile accidents or air-plane crashes, exposure to gasoline causes post-mortem detachment epidermis

 

—  Artefacts due to Refrigeration:

—  Pink hypostasis is seen in bodies kept in cold storage. Post-mortem refrigeration of infants usually solidify the subcutaneous fat which produces a prominent crease where there was a normal skin fold of the neck, which resembles strangulation mark

 

—  Toxicological Artefacts:

—  Faulty technique in collecting the sample, especially blood sample, can give false results.

—  When blood is collected from the heart with a long needle, it may be contaminated with stomach contents or regurgitated oesophageal contents. 

—  If blood is contaminated with pericardial or pleural fluids. False results are obtained as regards alcohol.

 

—  Embalming Artefacts:

—  The trocar wound may simulate a stab wound.

 

—  Interment and exhumation Artefacts:

—  In bodies which have been buried, fungus growth is usually seen at body orifices, eyes and at the sites of open injuries. 

—  Grave-diggers can produce post-mortem fractures, abrasions, and lacerations

DURING AUTOPSY

 

—  Air in Blood Vessels:

—  Pulling of the dura in the saggital line will cause the air to enter the blood vessels

 

—  Skull Fractures:

—  Fractures of skull usually in the middle fossae may be produced due to partial sawing and forceful pull of the skull cap or due to partial sawing and then using chisel and hammer to loosen the skull cap.

 

—   Visceral Damage:

—  Rough handling of the brain during removal may produce tears of the midbrain. 

—  Rough handling of the liver during removal may produce tears of the diaphragmatic surface, which simulate ante-mortem lacerations.

—  If the neck structures are pulled too hard during autopsy to drag out the thoracic viscera, they may be torn, and also transverse intimal tears may be produced in the descending aorta , vessels at the top of the brain.

 

Extravasation of Blood:

—  In case of suspected cranial injury, the body should be opened, and the cardiovascular system decompressed by opening heart before the head is opened.

 

Fracture of Hyoid Bone:

—  When the tongue and neck structures are firmly grasped and pulled upon while removing the neck organs, the hyoid bone and thyroid cartilage may be fractured, especially in old persons.

 

Injury to Blood Vessels:

—  While dissecting the neck structures, if toothed dissecting forceps in used, it may damage the intima of the carotid artery which resembles a tear, as is seen in case of strangulation.

 

Toxicological Artefacts:

—  They may be introduced due to: (a) Contamination of viscera with stomach contents during autopsy, or by putting all the organs in one container, or by using contaminated instruments or containers. (b) Faulty technique in collecting the sample (c) Faulty storage or use of preservatives.

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