title: [Intramuscular bleeding in deaths from an internal cause: forensically significant differential diagnosis between external trauma and hemorrhages occurring during agony].
abstract: Five cases of death from an internal cause are described in which bleeding into the muscles of the neck, the region of the shoulder girdle, the back of the thorax and partly the arms occurred during agony. As the cause of death was unclear at first and a violent crime could not be ruled out, a forensic autopsy was ordered in the course of which hemorrhages were detected which raised the differential diagnostic question whether extravasation might have been caused by an impact of blunt force. However, thorough investigation of the macroscopic and especially the microscopic structure of the lesions provided clear evidence that all the hemorrhages were due to internal causes. The pattern of these muscular lesions suggests intensified breathing with dyspnea leading to ruptures of the accessory respiratory muscles. Intramuscular bleedings of this type are a well-known phenomenon in legal medicine in connection with death by drowning, but have not been described in the medicolegal literature in cases of natural death from an internal cause so far.
authors.affiliation: Institut für Rechtsmedizin der Universität Hamburg.
authors.forename: Holger
authors.initials: H
authors.lastname: Lach
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schulz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000331:legislation & jurisprudence; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009203:Myocardial Infarction / Q000473:pathology; D009205:Myocarditis / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000473:pathology