At autopsy of a suspected custodial torture death, the forensic pathologist finds no external injuries. Which internal finding would MOST strongly support blunt trauma inflicted without external marks (a hallmark of 'clean torture')?

• A Subdural haematoma without scalp laceration, along with rib fractures at costochondral junctions and haemorrhage in paraspinal muscles without overlying skin bruising ✓
• B Pulmonary oedema with no pleural adhesions
• C Fatty change of the liver with intact skin
• D Petechial haemorrhages in the conjunctivae only

Explanation

Torturers may employ methods designed to produce severe internal injury without visible external marks — so-called 'clean torture' or torture leaving no marks. Classic findings include: subdural haematoma from shaking without scalp injury, rib fractures at costochondral junctions from squeezing, paraspinal muscle haemorrhage from 'falanga' (beating soles of feet — with internal foot findings), and testicular haemorrhage. Subdural haematoma without scalp laceration combined with rib fractures and muscle haemorrhage without overlying bruising is the classic autopsy constellation. Pulmonary oedema and fatty liver are nonspecific; isolated conjunctival petechiae suggest asphyxia rather than blunt trauma.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.