The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT

• Published in: British journal of radiology 2018-04, Vol.91 (1084), p.20170479-20170479
• Main Authors: Schulze, Katja, Ebert, Lars Christian, Ruder, Thomas Daniel, Fliss, Barbara, Poschmann, Sebastian Alexander, Gascho, Dominic, Thali, Michael Josef, Flach, Patricia Mildred
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asphyxia; Autopsy; Cause of Death; Diagnostic Radiology; Ear, nose and throat; Female; Fractures, Bone - diagnostic imaging; Gases; Humans; Hyoid Bone - diagnostic imaging; Hyoid Bone - injuries; Imaging, Three-Dimensional; Larynx - diagnostic imaging; Larynx - injuries; Male; Middle Aged; Sensitivity and Specificity; Suicide; Tomography, X-Ray Computed; Trauma
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr.20170479

The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma. In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case. Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (