Zátopková Lenka, Hejna Petr, Palmiere Cristian, Teresiński Grzegorz, Janík Martin
Department of Forensic Medicine, Charles University, Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, Hradec Králové, 500 05, Czech Republic.
CURML, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland.
Int J Legal Med. 2017 Sep;131(5):1423-1428. doi: 10.1007/s00414-017-1596-4. Epub 2017 Apr 29.
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.
即使在分子诊断和数字诊断取得进展的时代，低温的尸检诊断仍然存在问题。髂腰肌的大片出血被认为是低温致死的一个有用诊断标志；然而，自其最初被描述以来，它们受到的关注有限。本研究试图通过检查核心肌群出血的发生率、定位及诊断意义来填补这一空白，这些出血作为低温致死的证据，来自于连续51例低温尸检病例。在33例低温致死病例（65%）中发现了核心肌群出血。出血出现在髂腰肌（19例；37%）、背部深层肌肉（18例；35%）以及其他核心肌群，如膈肌、颈部肌肉、胸肌和肋间肌（11例；22%）。该研究结果提供了一个有吸引力的诊断机会，并再次证实了仔细解剖核心肌群对于明确低温死亡的潜力。缺乏高端成像技术和分子尸检程序的中心可能尤其受益，这可能对更广泛的尸检实践具有启示意义。
