Štěpánka Kučerová

An atypical impaling injury of the iliofemoral region

A 46-year-old man with a history of chronic alcoholismwas found at his home address dead lying next to barrelsfilled with flammable liquids and an iron picket fence witha gate into a nearby a forest area (Fig. 1). Examination ofthe scene revealed blood traces with pubic hair coveringthe surface of some of the iron spikes of the gate (Fig. 2).An emergency doctor evaluated the decedent and describeda bizarre tear-like wound of the right femoral region.Because of the unclear cause-of-death determination, thebody was referred for a medico-legal autopsy evaluation.External examination of the adequately nourished,174 cm, 80 kg adult male showed an apparent, channel-like tissue defect of the right femoral region with evidenceof multiple blunt impacts, as well as superficial sharp forcewounds, over the entire anterior surface of the body(Fig. 3). On the right anteromedial aspect of the proximalportion of the femoral region there was an extensive(20 9 20 9 13 cm), obliquely oriented, and irregularlyshaped laceration (Fig. 4a). The wound path penetrated andtransected the quadriceps femoris muscle, the right femoralartery, and vein and entered the right inguinal region(Fig. 4b). The wound track then ascended through theretroperitoneal space and pierced the right psoas majormuscle. There was pronounced hemorrhage into the softtissues along the wound channel and around the pubicregion (Fig. 4c). In addition, four cm to the left of theabove laceration, another obliquely oriented skin perfora-tion was discovered measuring three cm in its largestdimension, that communicated with the impaling wound.The anorectal area was free of injuries. As indicated,multiple abrasions, contusions, and sharp force woundswere also found: on the ventral aspect of the upperextremities there were multiple, small, irregularly shapedcutaneous abrasions, and one deep cutaneous laceration inthe left cubital fossa; on the anterior aspect of the thoraxthere were two oval contusions and multiple longitudinalabrasions. External examination of the lower extremitiesalso disclosed multiple abrasions, contusions, and superfi-cial incised wounds. Internal examination did not show anyother injuries except those described. Toxicological eval-uation of blood revealed a blood alcohol level of 220 mg/dL. Further toxicological investigations of the blood andurine were negative.The cause of death was extensive external blood losscaused by transection of the right femoral artery and veinas a result of an atypical impaling injury.It appeared that the decedent, under the influence ofalcohol, tried to climb over the picket fence and wasaccidentally impaled through the right femoral region.Thus, the manner of death was classified as accidental. Weassume that repeated falls prior to the fatal event and theuncoordinated movements and striking of the body againstthe fence while impaled was a plausible explanation for themultiple blunt force injuries on the anterior aspect of thebody.DiscussionRare injuries, such as impalements are sometimesencountered at autopsy. Impaling injuries usually result

An Unplanned Complex Suicide by Multiple Blank Cartridge Gunshots and Cutting

Blank firing guns are readily accessible in most countries due to an absence of legal regulations. These weapons are capable of causing lethal injuries. We report a rare case of secondary (unplanned) complex suicide committed with a knife and blank cartridge pistol. A 59‐year‐old man was found dead with three superficial incisions in his neck and a gunshot wound to the chest. The external examination revealed an entrance wound in the left chest region consistent with contact shooting. The appearance of a muzzle imprint suggested two discharges. The autopsy showed a slightly hemorrhaged but otherwise intact pericardium, blood in the pericardial sac, and a channel‐like defect in the anterior wall of the left cardiac ventricle. The cause of death was attributed to cardiac tamponade. To the best of our knowledge, this is the first reported case of unplanned complex suicide involving an unmodified blank firing gun.

Atypical stab injury suggesting ritual suicide

Sharp weapons have been one of the most common deadly tools in cases of homicide and suicide for a long time. Tentative incisions accompany the majority of suicides by sharp force and the absence of hesitation marks provokes questions about the manner of death. We present the bizarre fatality of a 41-year-old male with an isolated circumscribed incision on the right neck, where the body was found lying in a pool of blood in the shower of his apartment. The internal examination revealed a 4-cm-long channel-like defect running inwardly and downwardly along the right sternocleidomastoid region. The cause of death was external bleeding from an injured right carotid artery and internal jugular vein. The wound had clean non-contused margins without any conspicuous hesitation injuries. A fragment of a razor blade, found in blood splatters, was identified as the only potential injuring tool. The case was classified as a suicide.

Giant Lambl’s excrescence: a rare incidental finding at autopsy

An 88 year old man collapsed unexpectedly while being transported to a medical examination due to suspected bronchopulmonary infection. Additionally, he had complained of diffuse abdominal pain several hours prior to his death. Resuscitation efforts were unsuccessful and he was pronounced dead at the scene. Due to the unexpected nature of his death, the deceased was referred for postmortem evaluation. His past medical history included chronic obstructive pulmonary disease and ischemic heart disease. Postmortem examination showed unremarkable external findings, except for palpably fractured ribs caused by closed chest compressions performed during attempted resuscitation. Internal examination revealed segmental intestinal infarction secondary to acute occlusion of the superior mesenteric artery by thrombus superimposed upon severe atherosclerosis. Macroscopically, the infarcted section of the intestine appeared gangrenous, edematous, and diffusely dark-purple in color. Sectioning of the heart revealed a small, sea anemone-like structure on the surface of the tricuspid valve measuring 1.2 cm in diameter (Figs. 1, 2). In addition, further autopsy findings included diffuse peritonitis and mild intraperitoneal hemorrhage. Microscopic examination of the aforementioned endocardial structure with hematoxylin-eosin (Fig. 3a, b), Movat’s pentachrome (Fig. 3c), and Masson’s trichrome stains showed fragments of gelatinous, arborescent tissue covered by hyperplastic endothelial cells. All of these structures were composed predominantly of a myxoid stroma with occasional elastic fibers and small amounts of collagen, typical of a papillary fibroelastoma. The cause of death was transmural intestinal necrosis caused by acute arterial thrombotic occlusion sustained as the result of severe mesenteric atherosclerosis.