The Significance of Subendocardial Hemorrhages Detected in Forensic Autopsies
Introduction:In our study, our aim was to reveal the relationship between subendocardial hemorrhage (SEH) which can be seen macroscopically immediately beneath the endocardium, and emerge secondary to many conditions from direct cardiac, head, and abdominal traumas to hyperemia, and its location with cause of death, its diagnostic value (if any), and whether it can be evaluated as a vital finding.
Material and Method :285 autopsy cases diagnosed as SEH which were brought to the Group Presidency of Morgue Specialization Department of the State Institute of Forensic Medicine of Bursa were included in the study
Results: Study population consisted of 229 (80.4 %) male, and 56 (19.6 %) female patients. Thity-one cases of death were related to natural causes, while the most frequently detected pathological causes of death were isolated abdominal traumas (32.9 %), followed by isolated head traumas (31.9 %). While traffic accidents ranked first (35.1%) among the events leading to death. Among evaluated cases, SEH was mostly located on septum.
Discussion: To fully understand the yet inadequately elucidated pathogenic mechanisms of SEH , it should be accurately defined by histopathological analysis. Even though various causes of death seen in association with these lesions suggest more than one underlying pathogenic mechanism, because of their nonspecific characteristics, their possible roles as indicators of vitality (if any) should be reinforced by further studies.
Sheehan HL. Subendocardial hemorrhages in shock. Lancet 1940;1: 831–2.
Knight B. Forensic Pathology. 3rd ed. London: Arnold; 2004.
Harruf RC. Subendocardial hemorrhage in forensic pathology autopsies. Am J Forensic Med Pathol 1993;14:284–8.
Keil W, Rothämel T, Tröger HD. Subendocardial hemorrhage from the forensic medicine viewpoint. Beitr Gerichtl Med. 1991;49:45-53.
Rajs J. Left ventricular subendocardial hemorrhages. Study of their morphology, pathogenesis and prognosis. Forensic Sci 1997;10/2:80–103.
Rajs J, Falconer B. Cardiac lesions in intravenous drug addicts. Forensic Sci Int 1997;13/3:193–209.
Seidl S. Subendocardial hemorrhages. In: Tsokos M, editor. Forensic pathology reviews, vol. 2. Totowa, New Jersey: Humana Press; 2005. p.293–306.
Caesar R. Subendokardiale Blutungen. In: Remmele W, ed. Pathologie, Vol 1. Springer, Berlin, Heidelberg, New York, 1999, p. 243.
Yoshida K, Ogura Y, Wakasugi C. Myocardial lesions induced after trauma and treatment. Forensic Sci Int 1992;54:181–9.
Smith RP, Tomlinson BE. Subendocardial haemorrhages associated with intracranial esions. J Pathol Bacteriol 1954;68:327–34.
Matsui T, Baba M. Death from asthma in children. Acta Paediatr Jpn 1990;32:205–8.
Meixner K. Hämorrhagische Diathesen, subendocardiale Blutungen, Verblutung. In: Neureuter F, Pietrusky F, Schütt E, editors. Handwörterbuch der gerichtlichen Medizin und naturwissenschaftlichen Kriminalistik. Berlin: Springer; 1940. p. 336, 731, 884.
Mueller B. Gerichtliche Medizin. Heidelberg: Springer-Verlag; 1953.
Tsokos M, Türk EE, Uchigasaki S, Püschel K. Pathologic features of suicidal complete decapitations. Forensic Sci Int 2004;139:95–102.
Weintraub BM, McHenry LC. Cardiac anomalies in subarachnoid hemorrhage: a résumé. Stroke 1974;5:384–392.
McLeod AA, Neil-Dwyer G, Meyer CHA, Richardson PL, Cruickshank J, Bartlett J. Cardiac sequelae of acute head injury. Br Heart J 1982;47:221–226.
Sevitt S. Reflections on some problems in the pathology of trauma. J Trauma 1970;10:962–973.
McGovern VJ. Hypovolemic shock with particular reference to the myocardial and pulmonary lesions. Pathology 1980;12:63–72.
Koskelo P, Punsar S, Sipilae W. Subendocardial haemorrhage and E.C.G. changes in intracranial bleeding. Br Med J 1964;5396:1479,1480.
Leslie JB. Incidence and aetiology of perioperative hypertension. Acta Anaesthesiol Scand Suppl 1993;99:5–9.
Cechetto DF, Wilson JX, Smith KE, Wolski D, Silver MD, Hachinski VC. Autonomic and myocardial changes in middle cerebral artery occlusion: stroke models in the rat. Brain Res 1989;502:296–305.
Vögelin HP, Jutzi H, Gertsch M. EKG- und kardiale Veränderungen bei akutem Hirnschaden. Schweiz Med Wochenschr 1989;119:461–466.
Marion DW, Segal R, Thompson ME. Subarachnoid hemorrhage and the heart. Neurosurgery 1986;18:101–106.
Varga T, Szabo A. Herzveränderungen bei akutem intrakraniellen Druckanstieg. Z Rechtsmed 1978;80:311–318.
Plattner T, Yen K, Zollinger U. The value of subendocardial haemorrhages as an indicator of exsanguination and brain injury--a retrospective forensic autopsy study. J Forensic Leg Med. 2008 Jul;15(5):325-8.
Bakkannavar SM, Babu YPR, Ashwinikumar, Nayak VC, Manjunath S, Kumar P. Subendocardial haemorrhage in autopsied hearts. J Pharm Biomed Sci 2013; 26: 410-5.
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