Neck Hemorrhage: Fact or Artifact?-A Retrospective Analysis of Patterns of Postmortem Anterior Neck Muscle Hemorrhages From Hypostasis Versus Strangulation.

Abstract

Distinguishing artifactual postmortem hypostatic hemorrhages from injury is key to accurately diagnosing strangulation. Despite being a well-known phenomenon, the literature is limited. This retrospective case-control analysis characterizes anterior neck musculature hemorrhage patterns associated with postmortem artifact versus strangulation by comparing incidental neck hemorrhages noted on 20 autopsy reports from 2020 to 2021 to 10 strangulation controls from 2015 to 2021 in Northern Nevada. Cases were analyzed for body position and location/severity of musculature involvement. For artifact cases, 50.0% were prone, 40.0% supine, and 10.0% side-lying. A total of 55.6% of artifact cases and controls demonstrated neck hemorrhage laterality. A total of 80.0% of the prone cases versus 77.8% of supine had diffuse hemorrhage versus focal. A total of 63.2% of artifact cases involved the sternocleidomastoid versus 70.0% controls (P = 1.000), 26.3% involved soft tissues versus 20.0% (P = 1.000), 9.1% the sternohyoid versus 40.0% (P = 0.149), 27.3% the sternothyroid versus 60.0% (P = 0.198), 9.1% the thyrohyoid versus 10.0% (P = 1.000), 18.2% the omohyoid versus 30.0% (P = 0.635), and 10.0% the tongue versus 50.0% (P = 0.026). Despite the limitations, this study demonstrated that while prone positioning is a contributing factor to the development of anterior neck hemorrhages, there are other factors than postmortem hypostasis.