In a suspected case of homicidal neck compression, the deceased shows no external bruising on the neck. Which internal finding most reliably proves that the victim was alive when the neck was compressed?

• A Intimal tears of the carotid arteries
• B Postmortem congestion of the laryngeal mucosa
• C Parchmentisation of the neck skin
• D Haemorrhage into the strap muscles (sternohyoid and sternothyroid) ✓

Explanation

Haemorrhage into the deep neck muscles, especially the sternohyoid and sternothyroid, requires circulating blood pressure at the time of compression and is therefore a vital reaction proving antemortem neck violence. Postmortem compression produces congestion and even arterial intimal tears without extravasation, because there is no perfusion pressure to drive blood into tissue planes. Parchmentisation is a postmortem drying artefact of abraded skin and carries no vitality significance.

Reference: Knight's Forensic Pathology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.