PULMONARY MICROMORPHOLOGY IN FATAL STRANGULATIONS

Pulmonary histopathology was studied in a group of 106 fatal strangula tions including cases of hanging (n = 55; typical, n = 20; atypical, n = 35), ligature strangulation (n = 12), throttling (n = 15), combinat ions of throttling and ligature strangulation (n = 7) and other compre ssing force against neck (n = 17). The control group (n = 10) consiste d of cases of sudden cardiovascular death. The following results were obtained: intra-alveolar edema of different degree and strong hyperemi a could be regularly observed in nearly all cases, especially in fatal hanging (apart from the control cases, in this group the highest mean lung weights were observed). Further frequent histological patterns w ere perivascular and intra-alveolar hemorrhages, local dystelectasis a nd focal emphysema. Alterations of the lung vessel contents could be d etected in a varying extent: fat embolism (n = 7), mainly of minor deg ree, embolism of bone marrow tissue (n = 5) and intravascular cell acc umulations (n = 22). Embolism of fat and bone marrow tissue was nearly always restricted to cases with accompanying blunt force or resuscita tion measures. Whereas only 4 out of 55 cases of hanging revealed intr avascular cell accumulations (including different types of leukocytes and immature bone marrow cells), 18 out of 51 cases with the other for ms of strangulation exhibited this phenomenon. These accumulations mai nly occurred in a discrete and widely scattered manner, appeared in 3 out of 10 control cases (resuscitation measures) as well, and were lim ited to cases with either protracted courses or accompanying blunt vio lence. The following conclusions are drawn: the regularly observed gen eral changes of lung microstructure (e.g. edema, hyperemia) are undoub tedly non-specific for strangulation; the alterations of blood vessel contents may serve as a general vitality marker, if resuscitation meas ures are excluded, but not as an evidence of strangulating force. In c ases without signs of blunt force they point to protracted agony cours es (shock equivalents).