Dix Jay. Color atlas of forensic pathology

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FIGURE 3.22 He died from a blow to the abdomen which

caused lacerations of the liver. It is important to note there

were no external signs of injury.

FIGURE 3.23 This boy has spectacle hemorrhages. The black

eyes may occur from a direct blow to the eyes, side of the head,

or from blood seeping down around the eyes after fractures of

the skull. If there are no injuries around the eyes then the

hemorrhages probably came from fractures of the skull.

FIGURE 3.24 External injuries may not be present even if

someone dies of head trauma. This child reportedly fell and

struck his head. See next photo.

FIGURE 3.25 There were multiple areas of subscalpular hem-

orrhage which indicate the child was struck in the head and

did not fall.

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FIGURE 3.26 The blood on the skull (arrows) indicates

separate blows to the head.

FIGURE 3.27 Many fractures indicate more than one blow to

the head; however, unless there are definable points of impact,

the examiner must not “guess” as to the number of blows.

FIGURE 3.28 Fractures of the skull signify at least one blunt impact injury. The fracture at

the base of the skull in this case is called a “hinged” fracture because the front and back of

the skull can be moved like a hinge.

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FIGURE 3.29 Subarachnoid hemorrhage. When a blood ves-

sel ruptures over the base of the brain the blood accumulates

on both sides of the brain. This can be readily observed as

soon as the skull and dura mater are removed. See next photo.

FIGURE 3.30 A ruptured cerebral aneurysm (a ballooned-out

artery) will cause massive bleeding over the base of the brain.

FIGURE 3.31 This is an example of epidural hemorrhage.

The blood accumulates on the outside of the dura mater. The

bleeding usually has a disk shape and it originates by the rup-

ture of an artery. There is usually a fracture of the skull.

FIGURE 3.32 A subdural hemorrhage is blood under the

dura. It originates from ruptured veins. There may not be an

associated fracture of the skull.

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FIGURE 3.33 An old subdural hemorrhage may be discov-

ered incidentally during an autopsy. The healed area of bleed-

ing may become encapsulated (left) and can be removed,

leaving only a space.

FIGURE 3.34 Subdural hemorrhage on the base of the skull

of at least two days’ duration. The brain has been removed.

FIGURE 3.35 Another subdural hemorrhage seen after

removal of the brain.

FIGURE 3.36 A red/brown contusion of the brain.

FIGURE 3.37 Old bruises of the brain are yellow depressed

lesions (arrows). Recent bruises are red to brown.

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FIGURE 3.38 Contusions of the brain from a hammer blow.

FIGURE 3.39 There are extensive injuries to this brain

(arrow) from blows to the head. These injuries would be con-

sidered coup injuries if there were signs of external trauma on

the same side as the brain injuries.

FIGURE 3.40 This is contrecoup injury to the brain. The

overlying scalp and bone are not injured (arrow), indicating

the blow was on the opposite side of the head.

FIGURE 3.41 Multiple coup contusions and lacerations of the

brain caused by a heavy weapon.

FIGURE 3.42 Coup and contrecoup injuries in a traffic acci-

dent. Sometimes recreating the scene and how the person

received the injuries may be difficult, if not impossible.

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FIGURE 3.43 Intermediate contusions. The contusions

(arrows) occurred when the decedent was ejected from the car

and struck the top of his head on a tree.

FIGURE 3.44 More intermediate contusions occurring after a

blow to the top of the head while the head was in motion.

FIGURE 3.45 Injuries to the spinal cord may be obvious with prominent hemorrhage or

they may only appear as a softening caused by bone impingement. Most victims of spinal

cord injury who die do not have a “broken” neck because the bones of the vertebral column

slip over each other and do not break (subluxation).

FIGURE 3.46 Individuals with liver and bleeding problems

may have bleeding complications days after the trauma.

The bleeding in this brain occurred five days after the dece-

dent was struck in the head.

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Chapter 4

BLUNT TRAUMA CASES

FIGURE 4.1 Determining the manner of death in falls from

great heights may be difficult. See next photo.

FIGURE 4.2 The body of a young man was discovered on the

ground at the base of this cliff directly beneath the investigator

wearing the yellow jacket. See next photo.

FIGURE 4.3 There were few visible external injuries to the

body. Autopsy revealed significant head trauma. See next

photo.

FIGURE 4.4 The manner of death was determined in part by

the finding of an old scar and a recent incised wound on the

decedent's right wrist. Investigation also revealed the decedent

had been despondent.

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FIGURE 4.5 This man was working on a tower when he fell over 200’ to his death. He had

numerous injuries to his trunk and extremities. See next photo.

FIGURE 4.6 He landed with such force that some of his long

bones came through the skin. See next photo.

FIGURE 4.7 This shows the extent of the force. The bone

came through his boot.

FIGURE 4.8 A man was found dead on the sidewalk with

massive head trauma. See next photo.

FIGURE 4.9 On top of the building above the decedent, a

pulley device with counterweights had been knocked over by

high winds. See next photo.

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FIGURE 4.10 This is the metal counterweight which fell off

the building and struck the man in the head.

FIGURE 4.11 This man fell at his home. The impressive

amount of blood at the scene proves his death was not sud-

den. See next photo.

FIGURE 4.13 A closer view of the subdural hemorrhage. He

also had a hypertensive bleed into his brainstem which caused

him to fall and receive his other injuries.

FIGURE 4.12 The brain after the skull has been removed.

Both a subdural hemorrhage and contrecoup contusions were

present. See next photo.

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FIGURE 4.14 An elderly woman was sexually assaulted and

killed by multiple blows to the head. See next photo.

FIGURE 4.15 The damage to her head was obvious at the

scene and in the autopsy room. See next photo.

FIGURE 4.16 A pattern was discovered on the decendent’s

face. See next photo.

FIGURE 4.17 The suspect was wearing a pair of these boots.

See next photo.

FIGURE 4.18 The sole of the boot. See next photo.

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