Atlas of Forensic Pathology

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A Pattern-Based Approach

Atlas of F orensic P athology

Walter L. Kemp Rhome L. Hughes Jeffrey J. Barnard SERIES EDITORS Christina A. Arnold Elizabeth A. Montgomery Dora M. Lam-Himlin

a Pattern-Based approach atlas of forensic Pathology

WALTER L. KEMP, MD, PhD Montana State Chief Medical Examiner Forensic Science Division Department of Justice Billings, Montana Clinical Associate Professor Department of Laboratory Medicine and Pathology University of Washington School of Medicine Seattle, Washington

RHOME L. HUGHES, MD, MS Associate Professor School of Engineering Medicine

Texas A&M University College Station, Texas

JEFFREY J. BARNARD, MD Director and Chief Medical Examiner Dallas County Professor Department of Pathology University of Texas Southwestern Medical Center Dallas, Texas Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at shop.lww.com (products and services). The views expressed in this work are the private views of the authors and do not purport to reflect the official policy or position of the Food and Drug Administration or any part of the US Government, nor were the materials prepared as part of official government duties.

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Printed in Mexico

Library of Congress Cataloging-in-Publication Data

ISBN-13: 978-1-975222-50-5

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This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verifica tion of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

Walter L. Kemp: To Dr. McKenzie Jackson, for your love of pathology and the Forensic Files. Thank you for being my friend.

To my autopsy assistants, Kendra O’Neal and Tonya Shaffer, for your hard work and enthusiasm and for helping me stay sane while writing this book

To Hamo Muergerditchian, while not a physician, your assistance in my education was invaluable and much appreciated. I miss you.

To my wife, Kelly, and her dad, Parker, thank you for your patience, understanding, and support while I was writing this book

To my friend, Brian Kieffer, my life was simple compared to the challenges you have faced; with you as my friend, I will always remember what to be thankful for

To my Aunt Lucille, for being a shining example of kindness and generosity

Rhome L. Hughes: To my teachers who took the time to share an extra note of encouragement

To my students who took the time to think critically, study hard, and marvel at all the wonders to be learned

CONTRIBUTORS

GERALD CREGO, BA Undersheriff, Retired Missoula County Sheriff’s Office Missoula, Montana

LYNETTE LANCON, BS Forensic Firearm and Toolmark Examiner Forensic Science Division Montana Department of Justice Missoula, Montana ANDREW LEBRUN, D-ABMDI Deputy Sheriff/Deputy Coroner Carbon County Sheriff’s Office Red Lodge, Montana SCOTT SCHLUETER, BS, D-ABFT Forensic Toxicologist Forensic Science Division Montana Department of Justice Missoula, Montana

PREFACE

While many general forensic pathology books are available, forensic pathology atlases are relatively uncommon. This atlas primarily aims to assist the reader in interpreting the patterns produced by various findings inherent to forensic pathology but also to assist the reader in learning how to look for those patterns and how to document them when they are found. Forensic pathology does not have a World Health Organization (WHO) Classification guide, and classification systems for various topics in forensic pathology (eg, gunshot wounds and asphyxia) vary from author to author. For these and other reasons, forensic pathology as a specialty sees some degree of variance in practice and determina tions of the cause and manner of death between offices and between pathologists, with even experienced forensic pathologists arguing over the best practice in many areas as well as how to interpret certain autopsy findings. To maintain consistency of style and presentation of the information throughout this book, the text was written by one author (WLK) and reviewed by the remaining two authors (JJB and RLH). The book is therefore based primarily upon the education and 20 years’ experience of the lead author supplemented by the combined extensive experience of his two co-authors. The authors intend that the book will be viewed as a “user-guide” to forensic pathology, designed to assist a forensic pathologist in determining how to handle their daily cases, and not as a definitive guide to the field of forensic pathology, which in its degree of variation cannot adequately be described in an atlas or even in a textbook for mat. The authors hope the book will serve as a useful resource for those planning a career in forensic pathology (eg, pathology residents), or those who are early in their career in forensic pathology, and, hopefully, even offer at least a different perspective to those already well-trained in the field. If the reader wants a more in-depth review of certain topics in forensic pathology, other textbooks would better serve that purpose since based upon the relatively small amount of text space available in an atlas format, the information in this book is presented in a straight-to-the-point fashion and, hopefully, in a high-yield fashion, but as such presents the material in a different format than larger textbooks. The contribut ing authors are all non-forensic pathologists and were chosen for their expertise in various areas (firearms, postmortem toxicology, and death scene investigation), with the hope that readers could see how forensic pathologists can benefit from the input of such experts. PEARLS & PITFALLS: These entries are used to address important concepts or tech niques in forensic pathology that most often follow in-line with the text or images. The most common entries in the book are pearls and pitfalls and they were designed to highlight key concepts or useful points. FAQ: These entries are commonly used to address areas in forensic pathology that are not agreed upon by all forensic pathologists, or areas that are frequently important topics in forensic pathology but might not have a clear answer. In this regard, even the three authors do not necessarily completely agree on the best answer to some of the questions. As such, each of the FAQs is written as objectively and neutrally as possible, attempting to address two sides to an argument, and to present two views to the question if more than one legitimate view was felt to exist. The reader will also see that for many FAQs, based upon information available in the literature, there is no clear answer. CHECKLISTS: With certain types of investigations, a checklist is often provided to assist the reader in determining the steps to be taken at autopsy to identify or document the cause of death, as well as, in some situations, potential diagnoses to be considered in specific scenarios (eg, pregnancy-related deaths). SAMPLE NOTES: In the spirit of the other books in this series, the sample notes are written to offer methods to document autopsy findings, and methods to potentially certify the cause and manner of death, given certain scenarios and autopsy findings. With the documentation of autopsy findings as well as even the certification of the cause and manner

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Preface

of death, there is often more than one way to do the correct thing, and the sample notes tried to address that fact. NEAR MISSES: As with the other books in this series, the near miss section offers images and cases that have the potential to be mis-interpreted, or the potential to simply be missed. With each autopsy and investigation, there is usually always a chance to do more, and some near misses highlighted cases where an extra step brought the final answer.

ACKNOWLEDGMENTS

Completing this book was only made possible by what others have done for me through the many years. I would like to thank them for their direct and indirect contributions to my ability to write this book. To my mom and dad, Bill and Agnes Kemp, for always supporting my love of reading and education To Mr. Reckin, Mr. Simpson, Mr. Funk, Mrs. Roberts, Mr. Chalgren, Ms. Goyen, Mr. Cook, Ms. Gelardin, Mrs. Bland, and Mr. Hilderman for teaching me science, math, and English so that I could succeed in college To Dr. Addis, Father Harrington, Dr. Christianson, Dr. Westwell, and Mr. Bugni, for giving me the background to succeed in medical school To my medical school classmate Dr. Tom Nicholas, for convincing me to watch an autopsy To Dr. Dennis Burns, for being the best mentor in autopsy pathology (and neuropathol ogy) that a resident could ever ask for, and teaching me how to educate students To Dr. Jeffrey J. Barnard, for being the best mentor in forensic pathology that a resident and fellow could ever ask for, for teaching me how to handle the challenges innate to this field, for always promoting a learning environment, and for helping me with this book To Drs. Prahlow, Dolinak, Guileyardo, McClain, Spotswood, Townsend-Parchman, Urban, Salzberger, Turner, and Cohle, for teaching me forensic pathology To Drs. Weinberg, Rogers, Timmons, and Margraf, for teaching me pediatric pathology and To Drs. White, Bigio, and Rushing, for teaching me neuropathology To Dr. Schneider, for starting me on my teaching career and To Dr. Hesser, for asking me to teach the summer pathology course for medical students, and for giving me the motiva tion to develop my teaching interests To Bev Shackelford, for the copy of Richard Lederer’s Sleeping Dogs Don’t Lay , which greatly promoted my interest in better writing To Susan Kelly, for teaching me how to edit my own work, for teaching me how to read my own work as the reader and not as the writer, and for sticking with me as I learned the process To Dr. Gary Dale, for teaching me how to practice forensic pathology in a rural environ ment and in a coroner system, and for being a great work partner To Jerry Crego, Mickey Nelson, Dan Yonkin, and Richard Sine, for helping me write the coroner manual, for helping me fine-tune the coroner manual, and for teaching me a few things along the way To Drs. McKeown and Skelton, for teaching me anthropology, and To Dr. Graham, for teaching me statistics and pushing my academic limits for one last time To Dr. J. Bruce Beckwith, for teaching me pediatric pathology, and for teaching me that even the giants in medicine can still go by their first name To Dr. Sens, for accepting my application to join the faculty at UND-SMHS, which gave me the chance to teach 2nd year medical students again and To Dr. Koponen, for being a great work partner at UND To Dr. Rhome Hughes, for joining me at UND, for sharing our passion for teaching medical students, and for helping me with this book To Dr. Christina Arnold, for asking me to write this book, and having faith in my abilities to produce a worthwhile forensic pathology atlas and To Drs. Elizabeth Montgomery and Dora Lam-Himlin, for agreeing with Dr. Arnold that this book would be a worthy addition to the series. To Nicole Dernoski and Wolters-Kluwer, for accepting my proposal to write this book

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Acknowledgments

To the Wolters-Kluwer team, including Varshaanaa Muralidharan, Ariel S. Winter, and Maria McAvey, for helping me submit the book, always answering my questions quickly and working with my changes, and for helping to turn the documents and photos I submitted into the final product. To the team led by project manager, Ramkumar Soundararajan, along with Niraimathi in copyediting and Chandrasekar and Alexander in typesetting at TNQ Technologies for their work in producing the final book.

Thank you! Willy Kemp

CONTENTS

1 PATTERN INTERPRETATION IN FORENSIC PATHOLOGY...........................1

2 BASICS OF AUTOPSY....................................................................................5 Introduction.................................................................................................... 6 Hospital vs Forensic Autopsies......................................................................6 Validity of Hospital Autopsy Permit...............................................................7 Organ Removal at Autopsy............................................................................8 Documentation. ........................................................................................... 10 3 BASICS OF DEATH SCENE INVESTIGATION.............................................11 Introduction.................................................................................................. 12 Basics of Death Investigation.......................................................................12 Importance of Scene Investigation..............................................................14 Photography of the Scene and Body...........................................................14 Documentation of Postmortem Changes....................................................15 Documentation of Discovery History and Terminal Events..........................17 Near Misses..................................................................................................18 4 DEATH CERTIFICATION..............................................................................21 Introduction.................................................................................................. 22 Description of Cause of Death.....................................................................22 Description of Manner of Death..................................................................23 Description of Mechanism of Death............................................................23 Near Miss.....................................................................................................26 5 IDENTIFICATION.........................................................................................29 Introduction.................................................................................................. 30 Circumstantial, Presumptive, or Tentative Identification.............................30 How Formed .....................................................................................................30 Exclusionary Identification...........................................................................30 How Formed .....................................................................................................30 Positive Identification...................................................................................30 How Formed .....................................................................................................30 Scientific Methods to Identify a Deceased Body.........................................33 Introduction. ...................................................................................................... 33 Fingerprints.................................................................................................. 33 Requirements..................................................................................................... 33 Time Frame........................................................................................................33 DNA Analysis................................................................................................34 Requirements..................................................................................................... 34 Time Frame........................................................................................................35 Dental Examination......................................................................................35 Requirements..................................................................................................... 35 Time Frame........................................................................................................35 Other Forms of Scientific Identification.......................................................35 Non-Scientific Methods of Identification.....................................................36 Introduction. ...................................................................................................... 36 Visual Identification......................................................................................36 Method. ............................................................................................................. 36 Challenges......................................................................................................... 36

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Physical Findings on the Body.....................................................................36 Method. ............................................................................................................. 36 Challenges......................................................................................................... 36 Identification Cards......................................................................................37 Method. ............................................................................................................. 37 Challenges......................................................................................................... 37 Personal Effects............................................................................................38 Method. ............................................................................................................. 38 Other Methods.............................................................................................38 Near Miss.....................................................................................................39 6 POSTMORTEM CHANGES..........................................................................41 Introduction.................................................................................................. 42 Time of Death and Early Postmortem Changes..........................................42 Algor Mortis.......................................................................................................42 Postmortem Vitreous Potassium Measurements................................................44 Supravitality. ...................................................................................................... 44 Rigor Mortis.......................................................................................................44 Livor Mortis........................................................................................................46 Additional Findings Associated With Lividity....................................................49 Decomposition............................................................................................. 51 Important Terms Associated With Decomposition......................................52 Green Discoloration of Skin...............................................................................52 Adipocere. ......................................................................................................... 52 Postmortem Blisters (or Postmortem Bullae).....................................................53 Corneal Clouding...............................................................................................54 Hemolysis........................................................................................................... 54 Marbling............................................................................................................. 54 Mummification and Postmortem Drying............................................................54 Skin Slippage.....................................................................................................56 Swelling/Bloating............................................................................................... 57 Tache Noire........................................................................................................59 Scene Indicators...........................................................................................60 Postmortem Entomology.............................................................................61 How to Collect Appropriate Specimens for Time of Death Determination Using Insect Activity...................................................................62 Animal Activity.............................................................................................63 Embalming Artifacts.....................................................................................65 Near Misses..................................................................................................67

7 NATURAL DISEASE AT AUTOPSY...............................................................71 Introduction.................................................................................................. 74 Natural Disease of the Body in General.......................................................75 Autopsy Findings: Obesity.................................................................................75 Complications of Obesity..................................................................................75 Natural Disease of the Central Nervous System..........................................76 Introduction. ...................................................................................................... 76 Intracerebral Hemorrhage............................................................................76 Autopsy Findings...............................................................................................76 Etiologies of an Intracerebral Hemorrhage........................................................78 Cerebral Infarcts...........................................................................................78 Autopsy Findings...............................................................................................78 Lacunar Infarct..............................................................................................81 Autopsy Findings...............................................................................................81 Incompetent Diaphragm Sella.....................................................................82 Autopsy Findings...............................................................................................82 Natural Causes of Subarachnoid Hemorrhage............................................82 Autopsy Findings...............................................................................................82 Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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Etiologies of Subarachnoid Hemorrhage at Autopsy........................................82 Potential Mimics of Subarachnoid Hemorrhage................................................83 Meningitis..................................................................................................... 84 Autopsy Findings...............................................................................................84 Potential Mimics.................................................................................................85 Osmotic Demyelination Syndrome (Central Pontine

and Extrapontine Myelinolysis)....................................................................86 Autopsy Findings...............................................................................................86 Association......................................................................................................... 86 Potential Mimics.................................................................................................86 Globus Pallidus/Basal Ganglia Necrosis.......................................................86 Autopsy Findings...............................................................................................86 Association of Globus Pallidus Necrosis............................................................87 Multiple Sclerosis.........................................................................................88 Autopsy Findings...............................................................................................88 Chronic Traumatic Encephalopathy.............................................................88 Autopsy Findings...............................................................................................88 Seizure Disorder...........................................................................................89 Autopsy Findings...............................................................................................89 Association With Sudden Death........................................................................89 Alzheimer Disease........................................................................................90 Autopsy Findings...............................................................................................90 Diffuse Lewy Body Disease..........................................................................90 Autopsy Findings...............................................................................................90 Encephalitis.................................................................................................. 91 Autopsy Findings...............................................................................................91 Colloid Cyst..................................................................................................92 Autopsy Findings...............................................................................................92 Natural Disease of the Cardiovascular System............................................92 Introduction. ...................................................................................................... 92 Hypertensive Heart Disease.........................................................................93 Autopsy Findings...............................................................................................93 Association With Sudden Death........................................................................93 Coronary Artery Atherosclerosis..................................................................93 Autopsy Findings...............................................................................................93 Association of Coronary Artery Atherosclerosis With Sudden Death................96 Gross and Microscopic Aging of an Acute Myocardial Infarct...........................96 Complications of Acute Myocardial Infarct......................................................102 Aortic Dissection........................................................................................105 Autopsy Findings.............................................................................................105 Coronary Artery Dissection........................................................................105 Autopsy Findings.............................................................................................105 Associations..................................................................................................... 105 Abdominal Aortic Aneurysm......................................................................106 Autopsy Findings.............................................................................................106 Coronary Artery Aneurysm........................................................................107 Autopsy Findings.............................................................................................107 Associations..................................................................................................... 107 Aortic Stenosis...........................................................................................108 Autopsy Findings.............................................................................................108 Association With Sudden Death......................................................................108 Bicuspid Aortic Valve..................................................................................108 Autopsy Findings.............................................................................................108 Myxomatous Mitral Valve...........................................................................109 Autopsy Findings.............................................................................................109 Association With Sudden Death......................................................................110 Potential Mimics...............................................................................................110 Copyright © Wolters Kluwer, Inc. 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Chronic Rheumatic Mitral Valvulitis............................................................110 Autopsy Findings.............................................................................................110 Potential Mimic................................................................................................110 Endocarditis. .............................................................................................. 111 Autopsy Findings.............................................................................................111 Associations of Endocarditis............................................................................111 Pericarditis.................................................................................................. 113 Autopsy Findings.............................................................................................113 Etiologies of Pericarditis..................................................................................113 Myocarditis................................................................................................. 114 Autopsy Findings.............................................................................................114 Mimics of Myocarditis......................................................................................115 Cardiomyopathies...................................................................................... 116 Autopsy Findings.............................................................................................116 Association With Sudden Death......................................................................117 Mimics of Cardiomyopathy..............................................................................117 Coronary Artery Anomalies Associated With Sudden Cardiac Death.......118 Autopsy Findings: Anomalous Origin of a Coronary Artery............................118 Association With Sudden Death......................................................................118 Autopsy Findings: Tunneling/Bridging of Coronary Artery..............................119 Association With Sudden Death......................................................................119 Lipomatous Hypertrophy of the Interatrial Septum...................................119 Association With Sudden Death......................................................................120 Non-Ischemic Left Ventricular Scar............................................................120 Autopsy Findings.............................................................................................120 Associated With Sudden Death.......................................................................120 Lesions of the Cardiac Conduction System...............................................120 Introduction. .................................................................................................... 120 Atrioventricular Nodal Artery Dysplasia....................................................121 Autopsy Findings.............................................................................................121 Association With Sudden Death......................................................................121 Incidental and Other Microscopic Findings in the Heart...........................121 Clusters of Lymphocytes..................................................................................121 Basophilic Degeneration..................................................................................122 Contraction Band Necrosis..............................................................................122 Natural Disease of the Respiratory System................................................123 Introduction. .................................................................................................... 123 Pneumonia. ................................................................................................ 123 Potential Mimics of Pneumonia.......................................................................123 Aspiration Pneumonia................................................................................125 Autopsy Findings.............................................................................................125 Mimics.............................................................................................................. 126 Emphysema................................................................................................ 126 Autopsy Findings.............................................................................................126 Asthma....................................................................................................... 127 Autopsy Findings.............................................................................................127 Incidental Microscopic Findings in the Lung..............................................128 Corpora Amylacea...........................................................................................128 Lentils............................................................................................................... 128 Pulmonary Chemodectoma (Mesothelial-Like Rest)........................................128 Natural Disease of the Hepatobiliary System............................................129 Introduction. .................................................................................................... 129 Diffuse Fatty Liver......................................................................................129 Autopsy Findings.............................................................................................129 Potential Mimics...............................................................................................131 Copyright © Wolters Kluwer, Inc. 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Contents

Cirrhosis of the Liver..................................................................................132 Autopsy Findings.............................................................................................132 Potential Mimics...............................................................................................132 Complications of Cirrhosis...............................................................................133 Fitz-Hugh-Curtis Syndrome........................................................................135 Autopsy Findings.............................................................................................135 Acute Cholecystitis.....................................................................................135 Autopsy Findings.............................................................................................135 Acute Pancreatitis......................................................................................136 Autopsy Findings.............................................................................................136 Risk Factors for Acute Pancreatitis...................................................................136 Cavernous Hemangioma............................................................................138 Autopsy Findings.............................................................................................138 Association With Sudden Death......................................................................138 Other Incidental Liver Masses....................................................................138 Autopsy Findings.............................................................................................138 Natural Disease of the Genitourinary System............................................138 Introduction. .................................................................................................... 138 Nephrosclerosis.......................................................................................... 139 Autopsy Findings.............................................................................................139 Acute Pyelonephritis..................................................................................140 Autopsy Findings.............................................................................................140 Association With Sudden Death......................................................................141 Fournier Gangrene.....................................................................................141 Autopsy Findings.............................................................................................141 Incidental Renal Masses.............................................................................141 Adenoma. ........................................................................................................ 141 Renal Cell Carcinoma.......................................................................................141 Adrenal Gland Rest..........................................................................................141 Renomedullary Interstitial Cell Tumor..............................................................141 Natural Disease of the Endocrine System..................................................142 Introduction. .................................................................................................... 142 Features of Diabetes Mellitus....................................................................142 Autopsy Findings.............................................................................................142 Infarction of the Pituitary Gland.................................................................142 Autopsy Findings.............................................................................................142 Association....................................................................................................... 142 Hashimoto Thyroiditis................................................................................144 Autopsy Findings.............................................................................................144 Pheochromocytoma................................................................................... 144 Autopsy Findings.............................................................................................144 Incidental Findings.....................................................................................145 Myelolipoma.................................................................................................... 145 Black Thyroid...................................................................................................145 Natural Disease of the Gastrointestinal System.........................................145 Introduction. .................................................................................................... 145 Esophageal Inlet Patch (Salmon Patch)......................................................147 Autopsy Findings.............................................................................................147 Potential Mimics...............................................................................................148 Barrett Esophagus......................................................................................148 Autopsy Findings.............................................................................................148 Black Esophagus (Acute Esophageal Necrosis).........................................149 Autopsy Findings.............................................................................................149 Associations..................................................................................................... 149 Peptic Ulcer................................................................................................150 Autopsy Findings.............................................................................................150 Copyright © Wolters Kluwer, Inc. 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Ischemic Colitis...........................................................................................150 Autopsy Findings.............................................................................................150 Potential Mimic................................................................................................150 Intestinal Diverticula...................................................................................150 Autopsy Findings.............................................................................................150 Green Colon...............................................................................................152 Autopsy Findings.............................................................................................152 Potential Mimic................................................................................................152 Natural Disease of the Hematolymphoid System......................................153 Introduction. .................................................................................................... 153 Disseminated Intravascular Coagulation....................................................153 Autopsy Findings.............................................................................................153 Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome....153 Autopsy Findings.............................................................................................153 Fibrosis of the Splenic Capsule (Sugar Spleen)..........................................154 Autopsy Findings.............................................................................................154 Natural Disease of the Musculoskeletal System........................................155 Introduction. .................................................................................................... 152 Pregnancy-Related Deaths.........................................................................155 Introduction. .................................................................................................... 155 Amniotic Fluid Embolism...........................................................................156 Autopsy Findings.............................................................................................156 Acute Fatty Liver of Pregnancy..................................................................156 Autopsy Findings.............................................................................................156 Acute Endometritis-Myometritis................................................................156 Autopsy Findings.............................................................................................156 Placenta Accreta, Placenta Increta, Placenta Percreta...............................156 Autopsy Findings.............................................................................................156 Peripartum Cardiomyopathy......................................................................156 Autopsy Findings.............................................................................................156 Pre-Eclampsia/Eclampsia. .......................................................................... 157 Autopsy Findings.............................................................................................157 HELLP Syndrome........................................................................................157 Autopsy Findings.............................................................................................157 Ectopic Pregnancy......................................................................................157 Autopsy Findings.............................................................................................157 Near Misses................................................................................................158 8 ASPHYXIA..................................................................................................173 Introduction................................................................................................ 174 Specific Forms of Asphyxia Causing Failure of Oxygen to Reach the Lung.....................................................................................................178 Introduction. .................................................................................................... 178 Smothering. ..................................................................................................... 178 Choking............................................................................................................ 180 Mechanical Asphyxia/Traumatic Asphyxia/Positional Asphyxia.......................181 Vitiated Atmosphere/Suffocating Gases..........................................................183 Entrapment...................................................................................................... 183 Traumatic Asphyxia Combined With Smothering............................................183 Specific Forms of Asphyxia Causing External Compression

of the Neck.................................................................................................184 Hanging. .......................................................................................................... 184 Strangulation.................................................................................................... 190 Other Specific Forms Of Asphyxia.............................................................193 Carbon Monoxide Poisoning...........................................................................195 Drowning. ........................................................................................................ 195 Near Misses................................................................................................197 Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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