Atlas of Forensic Pathology

CHAPTER 3 Basics of Death Scene Investigation 19

Figure 3.5. Natural disease process with prominent hemorrhage. The decedent in Figure 3.5 has lung cancer that eroded into a ves sel, resulting in exsanguination.

Near Miss #2: Exsanguination due to lung cancer. While a copious amount of blood at the death scene is preliminarily concerning for a traumatic death, numerous natural disease processes can result in there being a significant amount of blood at the scene. Ruptured esophageal varices in patients with cirrhosis, a bleeding duodenal ulcer, hemorrhage from a skin neoplasm, or hemorrhage from a ruptured varicose vein can all result in a prominent amount of blood at the scene. In Figure 3.5, the decedent had lung cancer that eroded into a vessel. Near Miss #3: Contusion at scene versus at autopsy. At scene investigation, the coro ner identified a prominent bruise on the posterior surface of the right leg (Figure 3.6A); however, at autopsy, the bruise was not nearly as prominent (Figure 3.6B). The movement of unfixed lividity, decomposition, and other changes can easily alter the appearance of wounds from the time of the scene investigation until the performance of the autopsy. Near Miss #4: Elderly homicides can be very subtle, with minimal external exami nation findings. For example, an older female who is being cared for by her son is found dead in her bed, with only petechial hemorrhages on the conjunctivae and face iden tified by external examination. Autopsy identifies hemorrhage in the neck musculature. A high degree of caution is best when investigating any death of an elderly individual, even when they were expected to die. If care is not taken, these non-natural deaths can easily be missed.

A B Figure 3.6. Scene photographs versus autopsy photographs of images. On the posterior surface of the right leg is a prominent contusion ( A ), which was diminished in intensity, but still visible at the time of autopsy (arrow) ( B ). Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023