Forensic Pathology (eBook)

Photo Credits 13
Contributors 15
About the Authors 17
Acknowledgments 19
Foreword 21
Preface 23
1: Medicolegal Death Investigation 24
Case investigation 24
Autopsy report 25
Correlation 27
Cognition 27
Professional Liability 29
References 30
2: Death Scene Investigation 32
Scene etiquette 33
Natural death 35
Accident 42
Suicide 59
Homicide 71
Homicide-suicide 72
References 87
3: The Forensic Autopsy 88
The hospital autopsy 88
The forensic autopsy 88
Evidence collection 91
The autopsy report 92
Summary 93
References 93
4: Sudden Natural Death 94
Atherosclerotic cardiovascular disease 95
Hypertensive cardiovascular disease 99
Valvular disease 102
Nonatherosclerotic coronary artery disease 106
Myocarditis 109
Cardiomyopathy 111
Cardiac conduction system disorders 116
Central nervous system disease 118
Respiratory system 125
Gastrointestinal system 131
Endocrine system 133
Sepsis 135
Chronic ethanol abuse 137
References 139
5: Blunt Force Injury 144
External examination 145
Abrasion 145
Contusion 148
Laceration 152
Crush and chop injuries 153
Weapon identification 156
Explosive injury 157
Internal examination 158
Lethal blunt chest trauma and the negative (or nearly negative) autopsy 159
Medical complications of injuries 159
References 162
6: Sharp Force Injuries 166
Physical features of a knife 167
Anatomy of a stab wound 167
Notanda about stab wounds 169
Defensive injuries 172
Documenting stab wounds 173
Chop wounds 173
Sharp force injuries caused by other objects 174
Suicide 177
Dissection of incised wounds 178
Postinjury activity 179
Tool mark analysis 179
Dismembered bodies 181
Postmortem wounds 183
Decomposing bodies/bodies in water 184
References 185
7: Firearm Injuries 186
Fundamentals of wound ballistics 187
Entrance gunshot wounds 187
Distinguishing entrance from exit wounds 199
Exit gunshot wounds 201
Gunshot wounds in bone 203
Delayed gunshot wound deaths 207
Other injuries associated with firearms 208
Glaser safety slug 208
Taser 209
Technical approach to gunshot wounds 209
Shotguns 213
Rifles 220
References 223
8: Asphyxia 224
Petechiae 225
Suffocation 226
Vagal stimulation and rapid death 230
Positional, mechanical, and traumatic asphyxia 231
Hanging and strangulation 232
Autoerotic deaths 245
Incaprettamento 246
Carotid sinus stimulation 246
Asphyxial deaths in motor vehicle accidents 246
Resuscitation artifact 246
References 247
9: Drowning 250
Signs of drowning 251
Near drowning 253
Other artifacts of water immersion 254
Autopsies of bodies found in water 256
Dangerous aquatic life 257
Scuba diving 257
References 260
10: Environmental Injury 262
Thermal injury 262
Cremation 269
Spontaneous human combustion 269
Identification of fire victims 269
Carbon monoxide 269
Hyperthermia 270
Hypothermia 271
Electrocution 273
Chemical burns 276
Anaphylaxis 277
Hymenoptera and venom-related deaths 278
References 280
11: Motor Vehicle Collisions 282
Death certification in motor vehicle accidents 283
Motor vehicle crash scenes 284
Injuries sustained in motor vehicle crashes 287
Other thoracoabdominal vehicular occupant injuries 294
Ejected vehicular occupants 296
Automobile-pedestrian fatalities 297
Run over by vehicle 299
Vehicular conflagration 304
Motorcycle fatalities 306
Head and neck injuries in motor vehicle fatalities 307
References 311
12: Aviation 312
What type of accident is It? 312
Why did the plane crash? 312
Who should be autopsied and what are the goals of the autopsy? 313
Toxicology (the TOXBOX) 314
Manner of death determination 314
Falls to earth 314
Investigation of mass disasters 316
References 319
13: Death in Custody 320
Types of death in custody 320
Incongruity between incident account and physical injury 325
Police-involved shooting 329
Deaths occuring during or shortly after a violent struggle 330
Restraint sids 333
“Negative” photographs 334
References 339
14: Artifacts of Resuscitation and Complications of Medical Therapy 340
Artifacts of resuscitation 340
Artifacts of medical intervention 347
References 350
15: Apparent Natural Death in Infants 352
Sudden Infant death syndrome 352
Cosleeping/overlay 362
Wedging 364
Choking 365
References 366
16: Sudden Natural Death in Childhood 368
Complications of prematurity 369
Complications of cerebral palsy 369
Complica tions of down syndrome 369
Central nervous system pathology 370
Cardiovascular pathology 373
Respiratory and ENT pathology 376
Gastrointestinal pathology 381
Endocrine pathology 384
Hematopathology: sickle cell anemia 384
Infectious disease 385
References 389
17: Child Abuse 392
Introduction 393
Child abuse through the age spectrum 393
Blunt force injuries 400
Forensic osteology of child abuse 416
CPR-related trauma 423
Asphyxia 424
Thermal injury 425
Sharp force injuries and gunshot wounds 426
Neglect 428
Other forms of abuse 429
Artifacts and complications 429
Summary 431
References 432
18: Elder Abuse 436
The aging process 437
Types of elder abuse 437
Case investigation 443
References 443
19: Forensic Neuropathology 446
Scalp injury 447
Skull fractures 450
Epidural hemorrhage 452
Subdural hemorrhage 454
Subarachnoid hemorrhage 458
Cerebral contusion 460
Diffuse traumatic brain injury 465
Firearm injury 469
Sequelae of traumatic brain injury 471
Herniation 476
Post-traumatic meningitis 476
Persistent vegetative state 476
Respirator brain 477
Neck injury 477
Spinal cord injury 477
Artifacts 484
Spinal epidural abscess 484
References 485
20: Sexual Battery Investigation 490
Normal genital anatomy 491
Demonstration and evaluation of trauma to the vulva and introitus 494
The perianal examination 498
Examination of males 500
The negative examination 500
Adult victims of sexual assault 500
Medical therapy and follow-up of the assaulted patient 507
References 508
21: Toxicology 510
Collection of toxicology specimens 511
Drug screening 513
Ethanol (alcohol) 513
Ingested drugs 514
Drug abuse 515
Body “stuffer” versus body “packer” 519
Interpreting drug levels 520
Drug metabolites 521
Limitations of drug detection 521
Poisoning 522
Carbon monoxide toxicity 522
Miscellaneous 522
References 523
22: Acute Psychiatric and Emotional Deaths 526
Conditions with aberrant dopamine homeostasis 526
Schizophrenia 528
Stress deaths 529
References 530
23: Pregnancy 532
Pulmonary artery thromboemboli 533
Amniotic fluid emboli 534
Venous air emboli 535
Peripartum cardiomyopathy 536
Pregnancy and the long QT syndrome 536
Coronary artery dissection and aortic dissection 536
Intracerebral hemorrhage 537
Hemoperitoneum 538
Splenic artery aneurysm rupture 538
Uterine rupture 538
Preeclampsia/eclampsia/HELLP syndrome/liver rupture 539
Hepatic infarction 540
Acute fatty liver of pregnancy 540
Thrombotic microangiopathy 541
Disseminateda intravascular coagulation 542
Fetal effects of maternal injury 542
Complications of maternal and fetal injury 544
Homicidal maternal injury 544
Birth injury in the neonate 545
References 547
24: Postmortem Changes 550
Algor mortis 551
Livor mortis 551
Rigor mortis 555
Postmortem drying of the tissues 556
Putrefactive decomposition 558
Artifacts of embalming4 565
Exhumations 567
Second autopsies 568
Cremations 569
Trauma and the decomposing body 569
Animal scavenging 571
An approach to the autopsy of a decomposing body 573
Identification of decomposing bodies 574
Postmortem interval 575
References 577
25: Identification 578
General morgue procedures 578
General and unique body characteristics 578
Fingerprints 579
Disposition of “unknown” bodies 579
Uniquae physical characteristics 580
Implanted surgical devices 580
Tattoos 581
X-ray comparison 581
Photographic superimposition 584
Forensic facial approximation (visage) 584
Unknown persons databases 584
References 585
26: Forensic Osteology 586
Normal human osteology 587
Recovery of remains 589
Documentation of the scene 590
Skeletal and evidentiary inventory 592
Identifying features 594
Estimation of age at death 606
Estimation of stature 613
Bone trauma 614
Bone pathology 619
Forensic taphonomy 621
References 624
27: Forensic Odontology 628
Postmortem dental records 628
Antemortem dental records 629
Body identification without dental records 633
Bite marks 638
Patterned injuries from medical treatment 643
Bite mark analysis 643
Mistakes in interpretation: causes, prevention, and correction 649
References 652
28: Forensic Photography 654
Photographs to take 654
Photography pitfalls 655
Photography tips 659
29: Select Autopsy Topics 660
General autopsy biosafety 660
Infectious agents 661
Personal protective equipment 661
Reducing autopsy room hazards 661
Vaccination and tuberculin skin test 662
Note on prion diseases 662
Electrical concerns in the mortuary 664
Chemicals 664
Radiation 664
Facility design 664
Autopsy procedures 665
Forensic radiology 675
Bioterrorism and chemical agents 676
The negative autopsy 681
References 683
30: Death Certification 686
Cause of death 687
“Contributory conditions” or “other significant conditions” 687
Delayed deaths 687
The pending and amended death certificate 688
Mechanism of death 688
The manner of death 688
The “how injury occurred” box 689
Improper death certification 689
Red flags on review of a death certificate 690
Teaching proper death certification 691
References 691
31: The Pathologist as Expert Witness 692
Know your role 692
Scientific validity 693
Personal impartiality 693
Be prepared 693
Learn from each experience 693
References 694
Index 696