Atlas of Forensic Pathology

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CHAPTER 31 Special Dissections

HOW PERFORMED A pneumothorax can easily be detected with a radiograph of the chest; however, a pneumo thorax can also be identified through simple dissection procedures. As a routine part of the autopsy dissection, a small segment of intercostal muscle can be scraped from between the ribs (Figure 31.6A and B). With care, the parietal pleura can be left intact, and a pneumo thorax can be identified as the lung will not be present at the pleura. A pneumothorax can also be identified by creating a pocket with the reflected chest skin, filling the pocket with water, and incising into the pleural cavity below the level of the water, with air bubbling into the water as a sign of the pneumothorax. EXAMINATION FOR AIR EMBOLUS WHEN PERFORMED An air embolus commonly occurs with penetrating injuries of the neck, such as incised wounds or gunshot wounds, but can occur in a range of other situations. HOW PERFORMED A radiograph can reveal an air embolus. In addition, the heart can be opened in situ after filling the pericardial sac with water. Another method is to half fill a syringe with water and draw blood from the right ventricle of the heart and if air is present, it will bubble into the water in the syringe.

DISSECTION OF THE BACK WHEN PERFORMED

Dissections of the back are performed whenever there is a need to carefully document the presence or absence of trauma to the back. As blunt force injuries may not manifest at the skin surface but may be easily identifiable in the subcutaneous tissue, a back dissection is useful in those situations. Back dissections are commonly performed in the investigation of infant deaths and in-custody deaths but could also be useful in the investigation of elder abuse deaths and other homicides, including strangulation. Dissections of the back can and often do include reflection of the skin of the upper and lower extremities as well. In addition, for in-custody deaths, dissection of the soles of the feet in individuals with darkly pigmented skin, and incisions of the wrists to evaluate for hemorrhage associated with cuff marks can also be performed.

A B Figure 31.6. Dissection for a pneumothorax. While a chest radiograph can reveal a pneumothorax, the finding can also be identified via dissection. The intercostal musculature between two ribs ( A ) is gently scraped away, leaving the parietal pleura intact. The underlying lung should be identified up against the parietal pleura ( B ). Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023