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Haemorrhages in the posterior cricoarytenoid muscles--an unspecific autopsy finding
1Institute of Legal Medicine, Ludwig-Maximilians-University, Munich, Germany. keil@rechts.med.uni-muenchen.de
Insights
Posterior cricoarytenoid (PCA) muscle hemorrhages are not reliable indicators of death cause or manner. This study found no correlation, suggesting these hemorrhages lack diagnostic significance in forensic pathology.
Area of Science:
- Forensic Pathology
- Pathology
- Medical Science
Background:
- Atraumatic hemorrhages in posterior cricoarytenoid (PCA) muscles are found in 1-9% of deaths.
- Previous claims suggest an association with cause of death, particularly coronary events, and asphyxial mechanisms.
- It has been proposed that PCA hemorrhages could differentiate natural from unnatural deaths.
Observation:
- A review of 2060 autopsies identified PCA muscle hemorrhages.
- Six distinct cases were selected for detailed analysis, representing diverse causes of death.
- Cases included acute heart failure, bolus obstruction, drowning, severe trauma, exsanguination, and aspiration of vomit.
Findings:
- The analyzed cases exhibited varied circumstances of death, challenging previous associations.
- No consistent correlation was found between PCA muscle hemorrhages and the specific cause or manner of death.
- The study contradicts existing literature suggesting diagnostic value.
Implications:
- Posterior cricoarytenoid (PCA) muscle hemorrhages do not possess diagnostic significance in determining cause or manner of death.
- Forensic pathologists should not rely on PCA hemorrhages as indicators.
- Further research may be needed to understand the etiology of PCA hemorrhages in diverse death scenarios.
Abstract:
Atraumatic haemorrhages in the posterior cricoarytenoid (PCA) muscles can be observed for from 1% to 9% of various causes of death. It has been claimed that there is an association between these findings and the cause of death, particularly coronary death. Additionally it has been assumed that haemorrhages in the PCA muscles may be caused by an asphyxial mechanism and it has even been suggested that the haemorrhages may be a "sign" which could be used to differentiate between natural and unnatural death. Because of the differing views we carried out additional research into the course of these haemorrhages. Six characteristic cases out of 2060 autopsies with macroscopically diagnosed haemorrhages in the PCA muscles are presented. The six cases included acute heart failure, death caused by bolus, drowning, trauma of brain and skull, exsanguination from polytrauma and choking after aspiration of vomit. These cases were completely different with regard to all the circumstances of death. On the basis of these findings and in contrast to the literature it cannot be shown that proofs exist for a correlation between the haemorrhages and the causes and the manner of death. As a consequence it must be stated that haemorrhages in the PCA muscles do not have any diagnostic significance.