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Introduction: Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries., Case Outline: We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma., Conclusion: We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage.

Spontaneous pneumomediastinum is the presence of free air contained within the mediastinum, frequently associated with subcutaneous emphysema and of atraumatic origin. Frequency during childbirth is 1 in 100,000. We report the case of a 19 year old woman without respiratory disease history, in her first pregnancy with 39.5 weeks of gestation patient had, prolonged latent phase and sudden postpartum onset of dyspnea, thoracic pain and subcutaneous emphysema. Simple X ray film and thoracic tomography revealed the presence of free air in the mediastinum. The association of pneumomediastinum during delivery is an uncommon event.

Camouflaging Facial Emphysema, as is defined in this paper, is the result of a simple technique used by the patient to deform his face in order to prevent recognition at a police identity parade. The patient performs two punctures in the mucosa at the rear of the upper lip and, after several Valsalva manoeuvres, manages to deform his face in less than 15 min by inducing subcutaneous facial emphysema. The examination shows an accumulation of air in the face, with no laterocervical, mediastinal or thoracic affectations. The swelling is primarily observed in the eyelids and the orbital and zygomatic regions, whereas it is less prominent in other areas of the face. Patients therefore manage to avoid recognition in properly conducted police identity parades. Only isolated cases of self-induced facial emphysema have been reported to date among psychiatric patients and prison inmates. However, the facial emphysema herein described exhibits specific characteristics of significant medical, deontological, social, police-related, and legal implications., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

A 49-year-old male pedestrian was fatally injured when an overloaded truck backed over him and two of the truck's rear wheels rolled over his chest. An analysis is presented to estimate whether or not the subject would have been severely injured if the truck had been loaded to the maximum-permitted weight. The magnitude of compression of the subject's chest is predicted both for the case weight and the maximum-permitted weight of the vehicle. These predicted magnitudes of chest compression are then used to predict the probability of thoracic injury in both cases. The analysis suggests that loading by either the case weight or the maximum-permitted weight of the vehicle would have caused very severe compressions of the chest, likely resulting in multiple rib fractures, collapse of the ribcage and injury to the thoracic organs. Thus, this analysis suggests that severe, possibly life-threatening, thoracic injury would have occurred if the vehicle was loaded to its maximum-permitted weight.

Postmortem radiographic examinations of animals are often performed in judicial investigation to rule out gunshot and fractures due to cruelty. Literature describing postmortem changes seen on radiographs of animals is rarely available. Serial thoracic radiography of six recently euthanized dogs was performed in an interval of 8 h at a tropical ambient temperature of 22-33 degrees C. Severe decomposition of the cadavers prevented the study to be performed beyond 24 h. Gradual increment of gas accumulation in the pleural cavity, mediastinum, esophagus, blood vessels, cardiac chambers and subcutaneous tissue was observed. Lung changes observed were typical of alveolar pattern and subsequently collapsed secondary to severe pneumothorax. Vacuum phenomenon of the scapulohumeral joints which was not documented in humans was seen in four cadavers. Most radiographic changes were detected at 16 h post-euthanasia. Severe subcutaneous emphysema developed between 16 and 24 h post-euthanasia. This study showed that rapid postmortem changes which could be detected radiographically occur within 24 h of death at the ambient temperature of 22-33 degrees C.

Subcutaneous emphysema is a common condition occurring after chest injury. It may also be observed in association with pneumothorax or pneumomediastinum as a result of pathological changes in the respiratory tract. Spontaneous subcutaneous emphysema in absence of pneumothorax or pneumomediastinum is rare. We report a case of spontaneous subcutaneous emphysema in isolation secondary to fibrocavitatory lesion in the chest along with review of the literature.

Orbital emphysema is usually a benign, self-limited condition. Intraorbital extension of the entrapped air in the absence of an orbital fracture is extremely rare. Although benign, a careful periodic monitoring of intraocular pressure, optic nerve examinations, and prompt management are warranted in order to prevent tension pneumoobitus secondary to increasing intraorbital pressure by the orbital air.

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.

An unusual complication of craniofacial subcutaneous emphysema after evacuation of a chronic subdural haematoma is reported. The emphysema caused massive swelling and deformity of the patient's head and face, as well as the occlusion of both eyes, and it resolved spontaneously. The possible mechanisms of development of emphysema are discussed.