Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT
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ORIGINAL ARTICLE
Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT Vasiliki Chatzaraki 1 & Carlo Tappero 1,2 & Michael J. Thali 1 & Wolf Schweitzer 1 Accepted: 6 September 2018 / Published online: 13 November 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon’s bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon’s bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon’s bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon’s bleedings are present. Keywords Virtopsy . Postmortem computedtomography(PMCT) . Completehanging . Incompletehanging . Simon’s bleedings . Intervertebral disc vacuum phenomenon
Introduction Hanging is a frequent method of suicide [1, 3] whereby the body is suspended on a band around the neck [1–3]. Depending on whether the body is freely hanged or not, hanging is divided in two subtypes. In complete hanging the feet have no contact with a surface, whereas in incomplete hanging, part of the lower body, such as the knees or feet, partially
* Vasiliki Chatzaraki [email protected]; [email protected] 1
Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057 Zurich, Switzerland
2
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
support the weight of the body [1]. A short d
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