Pitfalls and Artifacts in the Neck at Autopsy

The diagnosis of strangulation at autopsy is a persistent challenge for the forensic pathologist. The main difficulty is interpreting the observations made at the postmortem table and deciding whether the observations are a sufficient basis to render an expert opinion that death was caused by external compression of the neck. This may have considerable importance to the criminal justice system and may lead to a conviction for murder. There are five main pitfalls and artifacts encountered in the neck at postmortem examination. These five areas provide the majority of the interpretative difficulties experienced by the pathologist. These challenges include: 1) developmental anatomy of the hyoid bone; 2) triticeous cartilages; 3) Prinsloo-Gordon hemorrhage; 4) postmortem hypostatic hemorrhage; and 5) resuscitation-related neck injury. This review explores these five areas. Awareness of the pitfalls and artifacts in the neck is essential for a satisfactory and evidence-based approach to interpreting observations of the neck at autopsy.