An autopsy case of internal jugular vein thrombophlebitis involving sepsis following blunt neck injury

Abstract We report an unusual case of delayed death due to sepsis following closed blunt injury to the neck. The victim was a 71-year-old male with a clinical history of hypertension, diabetes and gout. He was found dead about three weeks after being assaulted. He had not consulted a hospital after...

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Bibliographic Details
Published in:Journal of forensic and legal medicine 2008-02, Vol.15 (2), p.114-117, Article 114
Main Authors: Ishikawa, Takaki, MD, PhD, Zhu, Bao-Li, MD, PhD, Li, Dong-Ri, MD, PhD, Zhao, Dong, MD, Michiue, Tomomi, MD, Maeda, Hitoshi, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Blunt injury
C-Reactive Protein - analysis
Forensic Pathology
Hematoma - etiology
Hematoma - pathology
Humans
Jugular Veins - pathology
Male
Neck
Neck Injuries - complications
Neopterin
Neopterin - blood
Pathology
Sepsis
Sepsis - etiology
Streptococcus - isolation & purification
Thrombophlebitis
Thrombophlebitis - etiology
Thrombophlebitis - pathology
Time Factors
Venous Thrombosis - etiology
Venous Thrombosis - pathology
Wounds, Nonpenetrating - complications
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Summary:Abstract We report an unusual case of delayed death due to sepsis following closed blunt injury to the neck. The victim was a 71-year-old male with a clinical history of hypertension, diabetes and gout. He was found dead about three weeks after being assaulted. He had not consulted a hospital after the assault. Forensic autopsy demonstrated a large liquefied subcutaneous hematoma on the right side of the neck, peri- and thrombophlebitis of the right internal jugular vein. Otherwise, there was no evidence of trauma. Histological examination showed dermal vesicles in the skin covering the hematoma, accompanied by marked inflammatory cell infiltration phagocytosing gram-positive streptococci, subcutaneous edema, panphlebitis with partially organized thrombi and bacterial colonies, pulmonary edema and multiple pulmonary microthrombi involving bacterial aggregates. Postmortem serum C-reactive protein and neopterin levels were markedly elevated. These findings suggest sepsis as the cause of death, induced by infected internal jugular vein thrombophlebitis following blunt neck injury involving impaired skin barrier.
ISSN:1752-928X
1878-7487
DOI:10.1016/j.jflm.2007.04.003