Scalp, facial and gunshot injuries
Helen Whitwell, Christopher Milroy, Daniel du Plessis in Forensic Neuropathology, 2021
The smallest pattern of bleeding is a petechial haemorrhage or a petechia. Petechiae are pinhead-sized areas of bleeding found in the skin and internal organs. Although often described as a sign of asphyxia, they are by no means specific and are seen in a number of different causes of death, as well as non-fatal cases. In the head, they can be seen in the eyes (Figure 6.6a) and eyelids, on the face and behind the ears, as well as sometimes on mucosal surfaces (Figure 6.6b). Petechial-type haemorrhages on the undersurface of the scalp found following dissection are a well-recognised artefact and should not be interpreted as arising ante-mortem (see Chapter 5). In the absence of other external petechiae such as may be seen in external pressure to the neck, they are meaningless in determining the mode of death.
Granulomatous Diseases
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
Overview: Purpuric eruptions are subdivided into two types: non-thrombocytopenic (normal platelet) and thrombocytopenic (low platelet). Purpura may result from compromising the vessel walls (trauma, infection, vasculitis, collagen disorders) or due to hemostatic pathology (thrombocytopenia, abnormal platelet function, clotting factor deficiency, or abnormal clotting factor function). Other conditions may be associated with petechiae, including septicemia, immune thrombocytopenia (ITP), hemolytic uremic syndrome, leukemia, and coagulopathies (e.g., hemophilia). Non-thrombocytopenic purpura may result from coagulation disorders, connective tissue disorders, scurvy, or vasculitis. Thrombocytopenic purpura may be due to medications, immune disorders, septicemia, Rocky Mountain spotted fever, or systemic lupus erythematous.
Rocky Mountain Spotted Fever and Typhus Fever
James H. S. Gear in CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
Two different infectious diseases may occasionally present with similar rashes. A severely ill, jaundiced patient with leptospirosis may develop a diffuse morbilliform (erythematous) rash, particularly truncal in distribution. Weil’s disease may also be associated with petechiae or small ecchymoses. A mild form of leptospirosis (pretibial-Fort Bragg fever) caused by Leptospira autumnalis may show pink urticarial-like lesions on the anterior surface of the tibia (hence the name) and the pronator aspects of the forearm. Petechiae may develop within these erythematous lesions. A few scattered petechiae may occur in mild or severe leptospiral infections. The other infectious illness which may cause confusion is infectious mononucleosis. An exanthem is uncommon and, when it occurs, is usually attributable to a drug, especially ampicillin. These rashes are diffuse, erythematous, and “blotchy”. Within these lesions, petechiae may develop. In such cases, diagnostic help is derived from careful examination of the blood smear for unusual lymphocytes and serologic reactions. Pharyngitis with a tonsillar membrane is common in infectious mononucleosis.
Liver Cirrhosis Due to Fetal CMV Infection: A Case Report
Published in Fetal and Pediatric Pathology, 2023
Selvi Aydın Şenel, Kübra Kurt Bilirer, Selma Acar, Hakan Erenel
A 24-year-old woman gravida-1-para-0 at 20 weeks gestation was referred to our department due to fetal ascites. We observed fetal ascites, increased middle cerebral artery peak systolic velocity (1.98 MoM), placentomegaly, oligohydramnios, growth restriction and hyperechogenic bowel on ultrasound. Examination of fetal head showed asymmetrical echogenic areas in both hemispheres and midline shift suggesting severe intracerebral hemorrhage. We performed an amniocentesis followed by PCR testing for cytomegalovirus. CMV-DNA-PCR analysis was positive in the amniotic fluid. Termination of pregnancy was performed after counseling of the couple. The postabortal gross examination showed petechial lesions on the skin. Autopsy confirmed intracerebral hemorrhage. Macroscopic appearance of the fetal liver was nodular resembling macronodular cirrhosis (Fig. 1). We observed cytomegalic cells and "owl's eye" nuclear inclusion bodies (large eosinophilic inclusions surrounded by a clear halo) in the liver using immunohistochemical staining (Fig. 2a, b). Necrosis and fibrosis were highlighted by the reticulin stain (Fig. 2c, d). Prussian blue was used to exclude iron storage disorders. Histopathological diagnosis of cirrhosis was made.
Congenital Large Cutaneous Hemangioma with Arteriovenous and Arterioarterial Malformations: A Novel Association
Published in Fetal and Pediatric Pathology, 2019
Sihem Darouich, Houda Bellamine, Lasaad Mkaouar, Amira Ayachi, Mechaal Mourali
A 23-year-old woman, gravida 1 para 1, was referred to our institution at 32-week’s gestation for ultrasonographic evaluation of hydrops fetalis, placentomegaly and elevated middle cerebral artery-peak systolic velocity (61 cm/s) with normal amniotic fluid volume. On admission, anamnios due to spontaneous rupture of membranes was noted. Careful examination on color Doppler imaging showed a rich low velocity, arterial flow within a large cutaneous mass located on the right upper limb suggesting hemangioma and a peak systolic velocity of middle cerebral artery >1.5 MoM. An emergency cesarean was performed. A male neonate weighing 1700 g was delivered. He was profoundly depressed at birth with Apgar scores of 1 at 1 min and 4 at 5 min. Unfortunately, postnatal respiratory care failed and the neonate died 30 min after birth. Hematology workups and karyotype were not performed. Postmortem examination was carried out after parental consent. Macroscopic examination showed a hydropic male fetus with body weight of 1616.8 g, crown–heel length 35.5 cm, crown–rump length 24 cm and foot length 5 cm, which were consistent with gestational age of 27–28 weeks. The hemangioma was confirmed as a 5 × 5×3.5 cm raised reddish-violet and ulcerated mass with well-defined borders involving the posterior side of the right upper arm with marked perilesional edema (Fig. 1a,b). It was associated with an axillary prominent mass on the same side (Fig. 1b). Diffuse cutaneous petechiae were observed. They were more evident over the abdomen.
Reduction of Abdominal Adhesions with Elecrospun Fiber Membranes in Rat Models
Published in Journal of Investigative Surgery, 2018
Junsheng Li, Guanghui Ren, Weiyu Zhang
Animal experiments were approved by the Animal Ethics Committee of ZhongDa Hospital. A total of 64 rats were randomly divided into four groups. All the animals were fasted for at least 12 hr immediately before surgery. After hair removal, the abdomen was cleaned with 1% antiseptic povidone–iodine solution. The surgical procedure was conducted under general anesthesia using intra-abdominal injection of pentobarbital sodium (30 mg/kg). A 2-cm skin incision was made through the midline of abdomen. The cecum was exposed and abrased with moderate pressure using back of scalpel knife. Petechial subserosal hemorrhages developed in all cases (Figure 1). After different treatments were accorded to the four groups, the abdominal cavity was closed by a running 4-0 absorbable suture. The animals were sacrificed after two and four weeks. Samples for histological analysis were fixed in 10% phosphate-buffered formalin for 48 hr.
Related Knowledge Centers
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