Forensic and Clinical Forensic Autopsy

An Atlas and Handbook

Cristoforo Pomara, Vittorio Fineschi, Cristoforo Pomara, Vittorio Fineschi

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000245868
• Edition: 2
• Topic: Medicina
• Subtopic: Patologia

Forensic and Clinical Forensic Autopsy: An Atlas and Handbook, Second Edition, provides a step-by-step, photo-assisted guide illustrating the complete autopsy, from pre- through post-autopsy procedures.

All too often, forensic pathologists perform autopsies that are limited only to the body parts that are suspected, leading to biased and inaccurate results. A correct diagnosis for cause of death can only be reached by a strict and systematic examination of the whole body. The chapters of this book look at external cadaver examiner, organ removal methods, laboratory procedures, including recording and imaging techniques, microscopy applications, pediatric and fetal autopsies, and checking for genetic disease and DNA diagnosis. New chapters and sections to this edition cover histology and immunohistochemistry, in addition to the added coverage on forensic anthropology and molecular autopsy.

Key Features:

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• Includes new coverage of histology, immunohistochemistry, forensic anthropology, and molecular autopsy.

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• Provides numerous case studies outlining the real-world best practice with over 550 full-color, detailed photographs illustrating concepts.

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• Presents clear, step-by-step processes for completing autopsies consistently and systematically.

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• Details laboratory procedures, Forensic Applications of Microscopy, and new imaging techniques relative to standardized pre- and post-autopsy procedures.

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• Utilizes a series of forensic case studies to demonstrate each technique described and the approach used.

From macroscopic to microscopic approaches, Forensic and Clinical Forensic Autopsy, Second Edition, provides detailed guidelines for performance of autopsy on every part of the human body. Using these standardized protocols with the proper knowledge, training, and experience, pathologists – and students of pathology and forensic pathology – can rely on this book to help them develop the skills needed to become experts in their field.

A Methodological Approach to the External Examination	1
STEFANO D’ERRICO University of Trieste Monica Salerno University of Catania

Contents

1.1 Introduction

1.2 Clothing

1.3 Jewelry

1.4 Tattoos

1.5 Sex, Race, and Age

1.6 Height and Weight

1.7 Time of Death Indicators

1.8 General Recommendations

1.9 Head Examination

1.10 Neck Examination

1.11 Chest Examination

1.12 Abdominal Examination

1.13 Shoulder and Upper Extremities

1.14 Lower Extremities and External Genitalia

1.15 Dorsal and Lumbar Regions

Bibliography

1.1 Introduction

Pathologists must perform a careful external examination of the cadaver prior to the actual autopsy, as the external findings may sometimes be more important than anything revealed by the internal examination. The external examination often provides significant clues and sometimes may even reveal the cause of death. External examination is especially important in forensic cases where close attention to detail is mandatory. The examination must be documented with photographs and a full-written description of findings. Diagram sheets should also be used to graphically reproduce the locations of anatomical findings.

1.2 Clothing

Examination of the clothing should always be performed by the pathologist, not only in criminal cases or in cases of suspicious death, but also in traffic and industrial accidents, falls, and drownings. Each part of clothing should be carefully examined and described before and after its removal from the body. If clothes have been removed before transfer to the mortuary, the pathologist should always specifically ask for the clothes of the victim to be returned, especially when trauma is the provisional cause of death.

A record of size, type, make, and color of the clothing should always be created. In cases where trauma is thought to be the cause of death, body injuries should be matched with the damage found on the clothing, such as tears, slashes, stab wounds, and gunshot wounds. A complete photographic documentation of the clothes should be performed. The number, position, morphology, and size of lacerations should be noted. In cases of gunshot tears in the clothing, the tears should be “triangled” by measuring their distance from the upper, lower, and lateral landmarks. Gunshot residue on the clothing may provide vital evidence, revealing the range of the discharge and the type of ammunition. The Na rhodizonate technique should be used to examine bullet holes for gunshot residue.

When dealing with traffic fatalities, the clothing should be examined for tears, grease marks, road dirt, and broken lamp or windscreen (windshield) glass. Every metallic or plastic fragment related to the vehicle should be collected with the hope that it will eventually be possible to use these materials to reconstruct the event or identify the unknown vehicle in a hit-and-run. A careful inspection of pockets should also be performed. Because pockets can contain needles or other sharp objects, the examiner should always use forceps to avoid sharp injuries. All personal effects found need to be inventoried.

If possible, remove clothing in the usual way, by pulling the shirt over the head and limbs unless doing so might interfere with any injuries or cause soiling of the clothing. If rigor is intense, clothes may be cut off, taking care not to cut through preexisting damage or areas of staining already noted to be present on the garments. In cases of sudden infant death syndrome, examination of the clothing and diapers (which are often saturated with urine) is of particular importance. If a urine sample from the bladder has not been collected at the time of external examination, the diaper can be submitted for laboratory analysis as well as toxicological and metabolic screening.

Clothing examination is also very important in sex-related deaths. In these cases, the clothing of the victim could reveal the presence of bloodstains or seminal liquid, and the samples should be collected for genetic testing. As with any other type of traumatic death, the clothing should be carefully examined for tears, missing buttons, dirt, gravel, grease, and leaves. Their collection might aid in later efforts at scene reconstruction.

1.3 Jewelry

Jewelry must be inventoried and a short description (e.g., a yellow metal ring was worn on the fourth finger of the left hand) included. The presence of body piercing should be recorded.

1.4 Tattoos

The shape, size, site on the body, and color of any tattoo should always be recorded. Sometimes tattoos may be found inside the mouth (particularly the mucosa of the lips). Attempts at removal of a tattoo, which usually leave a typical and unique appearing scar, should also be noted.

1.5 Sex, Race, and Age

The sex, race (white, Afro-Caribbean, Asian, and so forth), and age of the cadaver are always recorded. The color of the skin sometimes may provide clues about possible diseases (yellow discoloration of skin and mucosa in liver disease, i.e., jaundice) or suggest the mechanism of death (e.g., cherry-pink colorations of carboxyhemoglobin in carbon monoxide poisoning). The sex of the decedent may not always be obvious; a body that is phenotypically female could be genetically male, or vice versa. Estimating the age of a cadaver is generally difficult, so when stating age, the pathologist should always indicate that the margin of error is at least 3–5 years. Finally, the general state of cleanliness of the body should be recorded; this is of particular importance in cases where neglect is considered the possible cause of death.

1.6 Height and Weight

Once undressed, the cadaver is weighed, preferably in kilograms. The height in centimeters is also measured from heel to crown (in infants, a more detailed measurement is taken). When the height and weight of the cadaver are known, the body mass index can be easily calculated using the formula BMI = weight (kg)/height (cm)². This is important to note because a BMI above 30 may suggest the presence of certain underlying diseases, such as hypertension, coronary artery disease, or diabetes. Some comment should be made on the general state of nutrition if it has not already been indicated in the general external examination. It should be noted whether the decedent was obese, emaciated, edematous, dehydrated, or well nourished. These are all important observations, but they cannot always be relied upon because in today’s work, addicts are increasingly likely to have a normal diet.

1.7 Time of Death Indicators

Body temperature should always be recorded, preferably at the scene. In jurisdictions where the physician does not always travel to the scene, experienced death investigators can, at least, take rectal, if not liver, temperatures. At the same time, the ambient air temperature should be recorded. Obviously, if the body is found naked in subzero weather, the observation alone may help to limit the differential diagnosis. The dictated report should also note the temperature at the time of autopsy and whether the cadaver had been refrigerated. The presence or absence of rigor mortis and distribution of livor mortis (hypostasis) should be documented at the scene and again at the time of autopsy.

1.8 General Recommendations

The cadaver should be inspected from head to foot (head, neck, chest, abdomen, pelvis), from the left to the right side, in supine and prone positions, including bot...