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How complicated central catheterization was interpreted at autopsy

"Therapeutic artefacts are a challenge for forensic pathologists for correct interpretation at autopsy" Rajanikanta et al (2020).

Abstract:

Therapeutic artefacts are a challenge for forensic pathologists for correct interpretation at autopsy. A 23-year-old female was found unconscious at home and immediately admitted to an emergency of a tertiary care hospital where resuscitative measures were taken. However, she died after 4 h of hospitalization. The injuries (abrasions, subcutaneous bruising and haemorrhage in the deep structures of the neck) discovered at autopsy simulated the findings of throttling and aroused the suspicion of homicide. Later, enquiry revealed that it happened due to mal-positioned central line in the carotid artery during internal jugular vein access to provide fluid as the patient was in shock due to aluminium phosphide (Celphos)poisoning. The bleeding diatheses in Celphos poisoning might have precipitated the extensive neck haemorrhage in this case.

Reference:

Rajanikanta S, Mohit C, Chittaranjan B. Complicated central catheterization in atypical celphos poisoning simulating throttling homicide: Review of neck resuscitation artefacts . J Forensic Leg Med. 2020;75:102050. doi:10.1016/j.jflm.2020.102050