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The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT
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...
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| Published in: | British journal of radiology 2018-04, Vol.91 (1084), p.20170479-20170479 |
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| Main Authors: | , , , , , , , |
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| container_end_page | 20170479 |
| container_issue | 1084 |
| container_start_page | 20170479 |
| container_title | British journal of radiology |
| container_volume | 91 |
| creator | Schulze, Katja Ebert, Lars Christian Ruder, Thomas Daniel Fliss, Barbara Poschmann, Sebastian Alexander Gascho, Dominic Thali, Michael Josef Flach, Patricia Mildred |
| description | 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 ( |
| doi_str_mv | 10.1259/bjr.20170479 |
| format | article |
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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 (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%.
The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.</description><identifier>ISSN: 0007-1285</identifier><identifier>EISSN: 1748-880X</identifier><identifier>DOI: 10.1259/bjr.20170479</identifier><identifier>PMID: 29327945</identifier><language>eng</language><publisher>England: The British Institute of Radiology</publisher><subject>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</subject><ispartof>British journal of radiology, 2018-04, Vol.91 (1084), p.20170479-20170479</ispartof><rights>2018 The Authors. Published by the British Institute of Radiology 2018 The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-ba1de55e847a836741ce0c285bd4d4fd13b6123f1543657c39413d0eaef91a733</citedby><cites>FETCH-LOGICAL-c450t-ba1de55e847a836741ce0c285bd4d4fd13b6123f1543657c39413d0eaef91a733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29327945$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schulze, Katja</creatorcontrib><creatorcontrib>Ebert, Lars Christian</creatorcontrib><creatorcontrib>Ruder, Thomas Daniel</creatorcontrib><creatorcontrib>Fliss, Barbara</creatorcontrib><creatorcontrib>Poschmann, Sebastian Alexander</creatorcontrib><creatorcontrib>Gascho, Dominic</creatorcontrib><creatorcontrib>Thali, Michael Josef</creatorcontrib><creatorcontrib>Flach, Patricia Mildred</creatorcontrib><title>The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT</title><title>British journal of radiology</title><addtitle>Br J Radiol</addtitle><description>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 (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%.
The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.</description><subject>Adult</subject><subject>Aged</subject><subject>Asphyxia</subject><subject>Autopsy</subject><subject>Cause of Death</subject><subject>Diagnostic Radiology</subject><subject>Ear, nose and throat</subject><subject>Female</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Gases</subject><subject>Humans</subject><subject>Hyoid Bone - diagnostic imaging</subject><subject>Hyoid Bone - injuries</subject><subject>Imaging, Three-Dimensional</subject><subject>Larynx - diagnostic imaging</subject><subject>Larynx - injuries</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Sensitivity and Specificity</subject><subject>Suicide</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><issn>0007-1285</issn><issn>1748-880X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpVkUtLxTAQhYMoen3sXEuWLqwmTdI0G0EuvkBwcwUXQkjTaW-kTa5JK_jvbfGBrobDfJw5zEHomJJzmgt1Ub3G85xQSbhUW2hBJS-zsiTP22hBCJEZzUuxh_ZTep2lUGQX7eWK5VJxsUAvqzXg1iRcjVXVAU6u9ZnBETpnZu187awZQsShwZ2JH74F0-EmGjuMEdIE4LXxrfMtDh5vQhqyPsQBerxcHaKdxnQJjr7nAXq6uV4t77KHx9v75dVDZrkgQ1YZWoMQUHJpSlZITi0QO8Wual7zpqasKmjOGio4K4S0THHKagIGGkWNZOwAXX75bsaqh9qCH6Lp9Ca6fkqsg3H6_8a7tW7DuxaqKAiZDU6_DWJ4GyENunfJQtcZD2FMmqpSFWR-8YSefaE2hpQiNL9nKNFzIXoqRP8UMuEnf6P9wj8NsE_tCIfS</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>Schulze, Katja</creator><creator>Ebert, Lars Christian</creator><creator>Ruder, Thomas Daniel</creator><creator>Fliss, Barbara</creator><creator>Poschmann, Sebastian Alexander</creator><creator>Gascho, Dominic</creator><creator>Thali, Michael Josef</creator><creator>Flach, Patricia Mildred</creator><general>The British Institute of Radiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201804</creationdate><title>The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT</title><author>Schulze, Katja ; Ebert, Lars Christian ; Ruder, Thomas Daniel ; Fliss, Barbara ; Poschmann, Sebastian Alexander ; Gascho, Dominic ; Thali, Michael Josef ; Flach, Patricia Mildred</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-ba1de55e847a836741ce0c285bd4d4fd13b6123f1543657c39413d0eaef91a733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Asphyxia</topic><topic>Autopsy</topic><topic>Cause of Death</topic><topic>Diagnostic Radiology</topic><topic>Ear, nose and throat</topic><topic>Female</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Gases</topic><topic>Humans</topic><topic>Hyoid Bone - diagnostic imaging</topic><topic>Hyoid Bone - injuries</topic><topic>Imaging, Three-Dimensional</topic><topic>Larynx - diagnostic imaging</topic><topic>Larynx - injuries</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Sensitivity and Specificity</topic><topic>Suicide</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schulze, Katja</creatorcontrib><creatorcontrib>Ebert, Lars Christian</creatorcontrib><creatorcontrib>Ruder, Thomas Daniel</creatorcontrib><creatorcontrib>Fliss, Barbara</creatorcontrib><creatorcontrib>Poschmann, Sebastian Alexander</creatorcontrib><creatorcontrib>Gascho, Dominic</creatorcontrib><creatorcontrib>Thali, Michael Josef</creatorcontrib><creatorcontrib>Flach, Patricia Mildred</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schulze, Katja</au><au>Ebert, Lars Christian</au><au>Ruder, Thomas Daniel</au><au>Fliss, Barbara</au><au>Poschmann, Sebastian Alexander</au><au>Gascho, Dominic</au><au>Thali, Michael Josef</au><au>Flach, Patricia Mildred</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT</atitle><jtitle>British journal of radiology</jtitle><addtitle>Br J Radiol</addtitle><date>2018-04</date><risdate>2018</risdate><volume>91</volume><issue>1084</issue><spage>20170479</spage><epage>20170479</epage><pages>20170479-20170479</pages><issn>0007-1285</issn><eissn>1748-880X</eissn><abstract>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 (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%.
The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.</abstract><cop>England</cop><pub>The British Institute of Radiology</pub><pmid>29327945</pmid><doi>10.1259/bjr.20170479</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Online; Alma/SFX Local Collection |
| 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 |
| title | The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT |
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