A Rare Case of Homicidal Asphyxia Involving Combined Mechanisms By Multiple Assailants.
Anna Laura Santunione, Jessika Camatti, Erjon Radheshi et al.
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Case in brief
A 20-year-old man was found inside a locked suitcase after a homicide. Examination showed facial cyanosis, subconjunctival and scleral hemorrhages, and patterned neck abrasions. Autopsy identified hemorrhage in the cervical soft tissues with a fractured greater horn of the hyoid, thoraco-abdominal blunt-force injuries with mesenteric hemorrhage, and pulmonary contusions with features of acute pulmonary emphysema. Histology supported that the injuries occurred during life, and toxicology was negative. Pathologic, imaging, and investigative evidence supported concurrent smothering, soft-ligature strangulation, and thoraco-abdominal compression as the cause of fatal mechanical asphyxia.
What made this case unusual
Three distinct asphyxial mechanisms—airway occlusion, neck compression, and thoraco-abdominal compression—were applied simultaneously by multiple perpetrators, complicating attribution of the fatal process.
Diagnostic / clinical pearl
When several asphyxial mechanisms may have acted together, integrate autopsy, histology, imaging, and investigative evidence to assess their combined contribution rather than assigning causation from a single finding.