De Donno A, De Fazio A, Greco M G, Introna F, Maglietta R A G
Section of Legal Medicine, Di.M.I.M.P., P.zza Giulio Cesare n.11, University of Bari, 70124 Bari, Italy.
Leg Med (Tokyo). 2008 Jul;10(4):204-9. doi: 10.1016/j.legalmed.2007.12.002. Epub 2008 Feb 20.
Dying in a head-down position is rare, and autopsy may reveal no morphological findings which can sufficiently explain the cause of death. The authors describe a case of positional asphyxia of a 78-year-old man, found dead hanging in head-down position inside a blackberry bush. The subject was suspended by his left leg and wedged inside a thick blackberry bush, while his right leg was free and inflected. Investigation revealed that the elderly man had last been seen after lunch in the early afternoon (about 2.00 p.m.), two days before being found. The subject had no pre-existing physical or mental condition which might have explained his death. He was 164 cm tall and weighed 90 kg (BMI: 33.4). External examination of the body revealed abrasions on the head and multiple superficial scratch marks on the hands; no external signs of violence were observed. The deceased's head was cyanotic and revealed marked petechial haemorrhages of the conjunctiva. Rigor mortis was fully developed and reddish fixed livor was observed on the face, neck and upper chest. The distribution of livor was consistent with the position of the body at the scene. Autopsy revealed marked pulmonary and cerebral oedema; the liver showed fatty vacuolization with a mild increase of connective tissue and thickening of the walls of the central veins and centrilobular sinusoids. The heart was enlarged, particularly the left ventricle, with a slight, calcified, diffuse and increased thickness of the aortic and coronary arteries. The remains of meat and vegetables in the initial phase of digestion were found inside the stomach, and there was a strong smell of alcohol. The blood alcohol concentration, ascertained by GC (Gas Chromatography), was 2.10 g/l. Toxicological assays for addictive drugs (cocaine, heroin, THC) yielded negative results. There were no features suggesting that the deceased had been the victim of an assault. The authors of this case report illustrate the main pathophysiological and diagnostic features of positional asphyxia and possible relevant co-causes of death, with an emphasis on the combined role of acute alcoholic intoxication and obesity in the hastened demise of a subject in the head-down position.
死于头朝下的姿势很罕见，尸检可能不会发现足以解释死因的形态学特征。作者描述了一例78岁男性的体位性窒息病例，该男子被发现头朝下悬挂在黑莓丛中死亡。死者左腿被悬吊，卡在茂密的黑莓丛中，右腿自由且弯曲。调查显示，老人最后一次被看到是在被发现前两天的午后早些时候（约下午2点）吃午饭的时候。死者生前没有可能解释其死亡的身体或精神疾病。他身高164厘米，体重90公斤（体重指数：33.4）。尸体外部检查发现头部有擦伤，双手有多处浅表划痕；未观察到外部暴力迹象。死者头部发绀，结膜有明显的瘀点性出血。尸僵完全形成，面部、颈部和上胸部观察到红色固定性尸斑。尸斑分布与尸体在现场的位置一致。尸检显示有明显的肺水肿和脑水肿；肝脏出现脂肪空泡化，结缔组织轻度增加，中央静脉和小叶中心窦壁增厚。心脏增大，尤其是左心室，主动脉和冠状动脉有轻微的、钙化的、弥漫性增厚。胃内发现处于消化初期的肉类和蔬菜残余物，并有强烈的酒精气味。通过气相色谱法测定的血液酒精浓度为2.10克/升。对成瘾性药物（可卡因、海洛因、四氢大麻酚）的毒理学检测结果为阴性。没有迹象表明死者是袭击的受害者。该病例报告的作者阐述了体位性窒息的主要病理生理和诊断特征以及可能相关的共同死因，重点强调了急性酒精中毒和肥胖在加速头朝下体位者死亡中的联合作用。
