title: An autopsy case of internal jugular vein thrombophlebitis involving sepsis following blunt neck injury.
abstract: We report an unusual case of delayed death due to sepsis following closed blunt injury to the neck. The victim was a 71-year-old male with a clinical history of hypertension, diabetes and gout. He was found dead about three weeks after being assaulted. He had not consulted a hospital after the assault. Forensic autopsy demonstrated a large liquefied subcutaneous hematoma on the right side of the neck, peri- and thrombophlebitis of the right internal jugular vein. Otherwise, there was no evidence of trauma. Histological examination showed dermal vesicles in the skin covering the hematoma, accompanied by marked inflammatory cell infiltration phagocytosing gram-positive streptococci, subcutaneous edema, panphlebitis with partially organized thrombi and bacterial colonies, pulmonary edema and multiple pulmonary microthrombi involving bacterial aggregates. Postmortem serum C-reactive protein and neopterin levels were markedly elevated. These findings suggest sepsis as the cause of death, induced by infected internal jugular vein thrombophlebitis following blunt neck injury involving impaired skin barrier.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan. takaki@med.osaka-cu.ac.jp
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Bao-Li
authors.initials: BL
authors.lastname: Zhu
authors.forename: Dong-Ri
authors.initials: DR
authors.lastname: Li
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
authors.forename: Tomomi
authors.initials: T
authors.lastname: Michiue
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D049429:Forensic Pathology; D006406:Hematoma / Q000209:etiology / Q000473:pathology; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D008297:Male; D019838:Neck Injuries / Q000150:complications*; D019798:Neopterin / Q000097:blood; D018805:Sepsis / Q000209:etiology*; D013291:Streptococcus / Q000302:isolation & purification; D013924:Thrombophlebitis / Q000209:etiology* / Q000473:pathology; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D019798:Neopterin; D002097:C-Reactive Protein