Unexpected delayed death after manual strangulation: need for careful examination in the emergency room



  • M. Di Paolo | marcodipaolo@med.unipi.it Institute of Legal Medicine, University of Pisa, Italy.
  • B. Guidi Institute of Legal Medicine, University of Pisa, Italy.
  • L. Bruschini ENT Unit, University of Pisa, Italy.
  • G. Vessio ENT Unit, University of Siena, Italy.
  • R. Domenici Institute of Legal Medicine, University of Pisa, Italy.
  • N. Ambrosino Pulmonary Unit, Cardio-Thoracic Department, University Hospital, Pisa, Italy.


The aim of this case report was to demonstrate the importance of detailed clinical assessment in victims of attempted manual strangulation, to prevent the occurrence of delayed death due to an airway collapse; and to provide an update on clinical management of these patients. An elderly male patient presented with a sore throat and speech impairment after attempting manual strangulation. Physical examination showed reddish skin of the neck, an extensive haematoma of the hard palate and anterior tongue. Flexible laryngoscopy failed to show any swelling of the hypopharynx or larynx. A few hours after presentation, the patient developed acute dyspnoea and died. Autopsy and post-mortem CT scan showed a haematoma in the thyro-epiglottal space. In conclusion, victims of manual strangulation can survive despite internal neck injury which can lead to delayed fatal airway collapse. This is because often there are few or no signs of assault, therefore medical evaluation should be thorough and timely. Sometimes immediate tracheotomy can be life saving.



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Case Reports
Manual strangulation, Delayed death, Autopsy
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How to Cite
Di Paolo, M., B. Guidi, L. Bruschini, G. Vessio, R. Domenici, and N. Ambrosino. 2016. “Unexpected Delayed Death After Manual Strangulation: Need for Careful Examination in the Emergency Room”. Monaldi Archives for Chest Disease 71 (3). https://doi.org/10.4081/monaldi.2009.359.

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