SpringerLink
Log in

The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) in autopsy cases of fatal hypothermia

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

We describe and discuss autopsy findings of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) within a study population comprising 36 cases of fatal hypothermia and 300 control cases. Synovial membrane hemorrhage and bloody discoloration of synovial fluid of the knees were seen in 27 cases of fatal hypothermia (75%). Though we are not dealing here with an obligatory autopsy finding in fatal hypothermia, the detection of the inner knee sign might be used as another corroborative sign of vital hypothermia after considering all differential diagnostic aspects. However, the absence of this finding does not exclude death due to hypothermia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Türk EE (2010) Hypothermia. Forensic Sci Med Pathol 6:106–115

    Article  PubMed  Google Scholar 

  2. Madea B, Preuß J, Lignitz E (2004) Unterkühlung: Umstände, Morphologische Befunde und ihre Pathogenese. Rechtsmedizin 14:41–59

    Article  Google Scholar 

  3. Madea B, Preuß J, Henn V, Lignitz E (2004) Morphological findings in fatal hypothermia and their pathogenesis. In: Oehmichen M (ed) Hypothermia—clinical, pathomorphological and forensic features. Schmidt-Römhild, Lübeck, pp 181–204

    Google Scholar 

  4. Lignitz E (2007) Kälte. In: Madea B (ed) Praxis Rechtsmedizin. Springer, Berlin, pp 185–190

    Google Scholar 

  5. Madea B, Tsokos M, Preuß J (2008) Death due to hypothermia—morphological findings, their pathogenesis and diagnostic value. In: Tsokos M (ed) Forensic pathology reviews, vol 5. Humana Press, Totowa, pp 3–21

    Google Scholar 

  6. Dettmeyer R (2011) Forensic histopathology. Springer, Berlin, pp 165–171

    Book  Google Scholar 

  7. Dirnhofer R, Sigrist T (1979) Muskelblutungen in Körperkern – ein Zeichen vitaler Reaktion bei Tod durch Unterkühlung? Beitr Gerichtl Med 37:159–166

    PubMed  CAS  Google Scholar 

  8. Richter M (1905) Gerichtsärtzliche Diagnostik und Technik. Hirzel, Leipzig

    Google Scholar 

  9. Preuß J, Dettmeyer R, Lignitz E, Madea B (2007) Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int 166:194–198

    Article  PubMed  Google Scholar 

  10. Simon A, Müller E (1971) Einige Aspekte zur Physiologie und Morphologie des Kältetodes unter besonderer Berücksichtigung der sogenannten Kälteschilddrüse. Kriminal Forens Wiss 6:131–138

    Google Scholar 

  11. Büchner F (1943) Die Pathologie der Unterkühlung. Klin Wschr 22:89–92

    Article  Google Scholar 

  12. Ishikawa T, Miyaishi S, Tachibana T, Ishizu H, Zhu BL, Maeda H (2004) Fatal hypothermia related vacuolization of hormone-producing cells in the anterior pituitary. Legal Med (Tokyo) 6:157–163

    Article  CAS  Google Scholar 

  13. Doberentz E, Preuß-Wössner J, Kuchelmeister K, Madea B (2011) Histological examination of the pituitary glands in cases of fatal hypothermia. Forensic Sci Int 207:46–49

    Article  PubMed  CAS  Google Scholar 

  14. Lignitz E, Henn V (2007) New autopsy signs in violent death. Forensic Sci Int 165:172–177

    Article  PubMed  Google Scholar 

  15. Yoshida C, Ishikawa T, Michiue T, Quan L, Maeda H (2011) Postmortem biochemistry and immunohistochemistry of chromogranin A as a stress marker with special regard to fatal hypothermia and hyperthermia. Int J Legal Med 125:11–20

    Article  PubMed  Google Scholar 

  16. Palmiere C, Mangin P (2011) Postmortem chemistry update part I. Int J Legal Med. doi:10.1007/s00414-011-0625-y

  17. DiMaio VJ, DiMaio D (2001) Forensic pathology. CRC Press, Boca Raton, pp 428–432

    Google Scholar 

  18. Saukko P, Knight B (2004) Knight’s forensic pathology, 3rd edn. Arnold, London, pp 414–420

    Google Scholar 

  19. Dolinak D, Matshes EW, Lew EO (2005) Forensic pathology. Principles and practice. Elsevier Academic Press, London, pp 248–250

    Google Scholar 

  20. Perper JA Microscopic forensic pathology. In: Spitz WU (ed) Spitz and Fisher’s medicolegal investigation of death. Charles C Thomas, Springfield, p 1117

  21. Weinke H (1996) Ein neues Zeichen beim Unterkühlungstod. 5. Frühjahrstagung der Deutschen Gesellschaft für Rechtsmedizin – Region Nord. Rostock, 10./11.05.1996

  22. Grobe N, Philipp K, Weinke H, Gibb B (1982) Befunde beim Tod durch Unterkühlung. 9. Regionaltagung Nord der Gesellschaft für Gerichtliche Medizin der DDR. Bad Saarow

  23. Mengel A (2009) Kältebedingte innere Kniegelenkbefunde beim Unterkühlungstod unter Berücksichtigung anderer kälteassoziierter pathomorphologischer Befunde. MD thesis. Greifswald

  24. Türk EE, Sperhake JP, Madea B, Preuß J, Tsokos M (2006) Immunohistochemical detection of hemoglobin in frost erythema. Forensic Sci Int 10:131–134

    Article  Google Scholar 

  25. Nikolić S, Zivković V, Juković F, Babić D, Stanojkovski G (2009) Simon’s bleedings: a possible mechanism of appearance and forensic importance—a prospective autopsy study. Int J Legal Med 123:293–297

    Article  PubMed  Google Scholar 

  26. Schulz F, Schäfer H, Püschel K, Tsokos M, Brinkmann B, Buschmann CT (2011) Bowel wall hemorrhage after death by hanging. Int J Legal Med 125:403–410

    Article  PubMed  Google Scholar 

  27. Schulz F, Buschmann C, Braun C, Püschel K, Brinkmann B, Tsokos M (2011) Haemorrhages into the back and auxiliary breathing muscles after death by hanging. Int J Legal Med 125:863–871

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Legal Medicine, Faculty of Medicine in Hradec Králové, Charles University in Prague, Šimkova 870, 500 01, Hradec Králové, Czech Republic

    P. Hejna & L. Zátopková

  2. Institute of Legal Medicine and Forensic Sciences, Charité, University Medicine Berlin, Turmstr. 21 (Haus N), 10559, Berlin, Germany

    M. Tsokos

Authors
  1. P. Hejna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Zátopková
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Tsokos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Hejna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hejna, P., Zátopková, L. & Tsokos, M. The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) in autopsy cases of fatal hypothermia. Int J Legal Med 126, 415–419 (2012). https://doi.org/10.1007/s00414-012-0677-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-012-0677-7

Keywords

Search

Navigation