The Autopsy Continued...

Figure 4

Figure 4 . (a) Ecchymosis of the right pinna and a small area anterior to the pinna; (b) the left ear has normal coloration. (c) Face of the victim showing ecchymosis of the eyes or “raccoon eyes” typical of basilar skull fracture. Extensive swelling on the right side of the face is also apparent.

Basilar Skull Fracture: There is evidence the victim also sustained basilar skull (bones at the skull base) fracture in addition to the depressed occipital skull fracture of the cranial vault. A clinical indicator of the presence of a basilar skull fracture is a purplish discoloration of the skin (ecchymosis) of the external ear and the skin over the mastoid (Fig. 3b) as well as portions of the anterior aspect of the right pinna (Fig. 4a); compare with the normal coloration of the left pinna, Fig. 4b. This is characteristic of a basilar skull fracture of the temporal pyramids at the skull base and is known as Battle’s sign. Figure 4c shows another classic clinical sign of a basilar skull fracture, ecchymosis around the eyes, known as raccoon eyes. This fracture is more anterior and involves the sphenoid bone. Both of these signs are the result of sustained bleeding from basilar skull fractures. Since the tissues at the skull base are firmly adherent, the perfusion pressure must be high enough for the blood to dissect between the bone and its covering tissue to produce these visible subcutaneous hematomas. The presence of these signs indicates the basilar fractures occurred while the victim maintained a significant systolic blood pressure. If the victim’s death was instantaneous, these classic signs of basilar skull fractures could not have developed.

Respiratory System: The autopsy report states the victim not only had blood in his large breathing passages, but the blood filled his alveoli, producing hemorrhagic frothy fluid. This was discovered when the lung tissue was sectioned at autopsy. The right lung weighed 970 grams and the left lung 440 grams. The average normal male adult lung weights are 450g (R) and 375g (L). Therefore, there was an excess of approximately 545g in the right lung. The autopsy report concluded the extra weight was blood. The specific gravity of blood is 1.058, indicating there was slightly more than 500 ml of aspirated blood in the right lung. The left lung weighed 440 grams indicating there was very little aspirated blood in the left lung. The excess lung weight could not be a result of terminal neurogenic pulmonary edema, because the excess weight would be evenly distributed to both lungs. Consequently, the victim had to have been lying on his right side when he aspirated the blood into his right lung. Central neurogenic hyperventilation is a characteristic respiratory pattern seen in severe brain stem injuries where the victim is near death. After a severe brainstem injury where a laceration of the pharynx was present, the ensuing hyperventilation would explain the presence of one-half liter of blood in the right lung.