Asphyxial and Petechiae

ABSTRACT:

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonaphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.

Conjunctival and facial petechiae have been regarded as classic signs of asphyxial deaths (1–11). First described by Tardieu in the nineteenth century, external and visceral petechiae have since been interpreted as hypoxia-related sequelae of asphyxia, sometimes being attributed in part to......