Dissecting Thoracic Aortic Hematoma Masquerading as Blunt Force Injury of the Neck

Discoloration of the skin of the anterior and lateral neck may raise suspicion for blunt force injury, particularly cervical compression, in an unwitnessed death. We present a case of an elderly woman with an unwitnessed death at home which highlights an external examination finding of blue/purple d...

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Bibliographic Details
Published in:Journal of forensic sciences 2015-07, Vol.60 (4), p.1093-1094
Main Authors: Wiens, Andrea L., Felo, Joseph A.
Format: Article
Language:English
Subjects:
Aged, 80 and over
Aorta, Thoracic - injuries
Aorta, Thoracic - pathology
aortic dissection
Atherosclerosis - complications
Atherosclerosis - pathology
atherosclerotic cardiovascular disease
Autopsies
autopsy
blunt force trauma
cervical compression
Diagnosis, Differential
Ecchymosis - etiology
Ecchymosis - pathology
Female
forensic science
Forensic sciences
Heart
Hematoma - pathology
Humans
Neck
Neck Injuries - diagnosis
Rupture, Spontaneous - etiology
Rupture, Spontaneous - pathology
Thrombosis - etiology
Thrombosis - pathology
Wounds, Nonpenetrating - diagnosis
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Summary:Discoloration of the skin of the anterior and lateral neck may raise suspicion for blunt force injury, particularly cervical compression, in an unwitnessed death. We present a case of an elderly woman with an unwitnessed death at home which highlights an external examination finding of blue/purple discoloration of the skin of the neck and links this finding with those from internal examination at autopsy. Pertinent negatives include absence of conjunctival and mucosal petechiae, absence of cutaneous abrasions of the neck, and absence of contusions of the anterior neck musculature. This case illustrates a natural disease entity, spontaneous dissection of a thoracic aortic hematoma, masquerading as blunt force injury externally and highlights the importance of having an appropriate index of suspicion when triaging jurisdictional cases for postmortem examination to accurately determine cause and manner of death.
ISSN:0022-1198
1556-4029
DOI:10.1111/1556-4029.12754