Positional asphyxia in a work-related fatality

Positional or postural asphyxia occurs when a particular body position interferes with adequate respiratory movements for a lengthy period of time. Death is usually accidental and associated with alcohol or drug intoxication, disability, or restraint. We report on the case of a 42-year-old man found unresponsive while working on farmland. The upper part of his body (head and upper limbs) was trapped in the highest and largest opening of the atomizer of a high-volume sprayer tank while his legs were hanging down. Bruises and abrasions were found on both suprascapular regions. Tramline bruises encircled the body between the abdominal and thoracic regions in line with the morphology of the tank's opening where the body was found. Cyanosis and petechial hemorrhages were found on his face, conjunctives, neck, and superior chest; the lungs were edematous. Toxicological analyses of body fluids were negative. The cause of death was postural asphyxia, and the manner of death was certified as a fatal accident at work. Work-related postural asphyxia has rarely been described in the literature. Scene investigation, autopsy, and toxicological analyses play a key role in the reconstruction of the dynamics involved in occupational events, in turn allowing the identification of any legal responsibilities of the worker or the employer.