Schulze Katja, Ebert Lars Christian, Ruder Thomas Daniel, Fliss Barbara, Poschmann Sebastian Alexander, Gascho Dominic, Thali Michael Josef, Flach Patricia Mildred
1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland.
2 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern , Bern , Switzerland.
Br J Radiol. 2018 Apr;91(1084):20170479. doi: 10.1259/bjr.20170479. Epub 2018 Feb 1.
The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma.
In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case.
Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%.
The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.
评估缢吊案例中喉结构附近组织内气体的存在情况，即“气泡征”，作为颈部创伤的诊断指标。
本研究对35例缢吊受害者的尸体剖验CT（PMCT）扫描及尸检进行检查，以揭示年龄相关变化、喉骨折、骨折部位及气体存在情况。选取心脏骤停或中毒的匹配组作为对照（n = 35）。每例均进行尸检。
不完全悬吊是缢吊最常见的方式。甲状角（90.5%）被确定为最易发生骨折的部位。仅在PMCT上检测到的喉畸形和脱位在57.1%的病例中出现，且83.3%与骨折同时存在。喉骨折在高龄者（>40岁，88.9%）中更常见，而在年轻受试者（<40岁，29.4%）中较少见。关于喉骨折的气泡征敏感性为79.2%，阳性预测值为95%，特异性为90.9%，阴性预测值为34.
