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Abstract
The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.
Highlights
In forensic autopsy practice, diagnosing the cause of death of immersed corpses is a very difficult task
Reuter reported that 11.5% [18] or 13.2% [19] of drowning cases had hemorrhage in the respiratory and accessory respiratory muscles, and the author argued that such intramuscular hemorrhage was due to spasmodic dyspnea occurring during the drowning process
Contrary to our expectation, the presence or absence of bleeding tendency had no significant effect on either the frequency of intramuscular hemorrhage or the number of muscles with hemorrhage. Such intramuscular hemorrhage of immersed corpses does not need to be considered as the influence of bleeding tendency
Summary
Among the forensic autopsy cases performed at the Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University between January 1, 2009 and. We retrospectively examined the gender, age, location of drowning, season, average temperature in the month of discovery, and effect of a potential bleeding tendency due to disease (e.g., liver cirrhosis) or medication (e.g., anticoagulants, antiplatelet agents) in the cases of hemorrhage in the respiratory and accessory respiratory muscles of the neck and chest that were not due to injury or cardiac massage therapy based on autopsy records and information from police investigations. The relationship between the number of muscles with hemorrhage and these epidemiological factors was examined. The number of muscles was counted as 1 if hemorrhage was observed unilaterally. A value of p
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