Asphyxial Deaths and Petechiae: A Review

Abstract

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonaphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.

Petechial bleedings in sudden infant death

“…All authors agree with the mechanical origin, i.e. rupture of vessels due to increased intravascular pressure [18]. But there also exist several predisposing or modifying factors such as age, gender, constitution and heart weight [28].…”

Suicidal ligature strangulation utilizing cable ties: a report of three cases

“…3. As clarified by Ely and Hirsch [11] petechial hemorrhages are not found in all cases of asphyxiation.…”

“…In our third case no petechial hemorrhages were observed. Ely and Hirsch [11] in a review of the literature concluded that petechiae of the head are the product of purely mechanical vascular phenomena: namely, ''impaired and obstructed venous return in the presence of continued arterial input'' and that ''no relationship exists between the development of petechiae and the presence or absence of asphyxia.'' We believe that in our third case the tensioning tool that was used to tighten the ligatures rapidly created a very high pressure which compressed both jugular veins and carotid arteries simultaneously and thus there was no vascular congestion of the head and neck to produce petechial hemorrhages.…”

The Analysis of the Cause-Effect Relation between Tractor Overturns and Traumatic Lesions Suffered by Drivers and Passengers: A Crucial Step in the Reconstruction of Accident Dynamics and the Improvement of Prevention

“…Obviously, this compression of the chest does not only produce haemodynamic effects (increase in the peripheral venous pressure in the upper body, associated with the continued arterial blood flow towards the periphery) but also respiratory consequences, with hypoxaemia caused by the arresting of breathing movements and alveolar ventilation [18,21,31,[33][34][35][36][37].…”