Fatal Positional Asphyxia Following Entrapment in an Inverted Body Position: Conventional Autopsy and Postmortem CT Cadaveric Examination
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 16 (2026),
1 January 2026
,
Page 1-8
https://doi.org/10.22037/ijmtfm.v16.53513
Abstract
Background: Positional asphyxia is a form of mechanical asphyxia resulting from body positioning that interferes with adequate ventilation and venous return, ultimately leading to fatal hypoxia.
Case Presentation: This report presents the case of a 45-year- old woman who died following accidental entrapment in an inverted position after falling head-first into a shallow trap-like domestic concrete structure. The unusual body position, combined with restricted thoraco-abdominal movement and impaired respiratory mechanics, led to fatal positional asphyxia. Postmortem computed tomography and conventional autopsy demonstrated pronounced signs of mechanical asphyxia, including brain and pulmonary edema, severe cyanosis of the face, intense livor mortis, and internal hemorrhages over the diaphragmatic muscle near the tendinous parts. Additional findings included bilateral nail injuries, while toxicological examination revealed no alcohol, drugs, or other toxic substances.
Conclusion: The case highlights the importance of scene investigation and correlation between radiological and autopsy findings in establishing positional asphyxia as the cause of death.
- Positional asphyxia, Postmortem computed tomography, Brain edema, Pulmonary edema
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References
[1] Chmieliauskas S, Mundinas E, Fomin D, Andriuskeviciute G, Laima S, Jurolaic E, et al. Sudden deaths from positional asphyxia: A case report. Medicine (Baltimore). 2018;97(24):e11041. [DOI: 10.1097/MD.0000000000011041]
[2] Saukko P, Knight B. Knight’s Forensic Pathology. 3rd ed. London: Arnold; 2004. p. 352-67.
[3] Sauvageau A, Boghossian E. Classification of asphyxia: the need for standardization. J Forensic Sci. 2010;55(5):1259-67. [DOI: 10.1111/j.1556-4029.2010.01459.x]
[4] D’Elia F, Da Broi U, Simonit F, Cappelli A, Cividino S, Zaninelli M, et al. Fatal asphyxia in the head-down position: An uncommon case of accidental work-related death. Am J Forensic Med Pathol. 2025;46(4):348-52. [DOI: 10.1097/PAF.0000000000001068]
[5] Falk J, Riepert T, Iffland R, Rothschild MA. Tod infolge ungewöhnlicher Lage des Körpers – ein Beitrag zur Bedeutung des venösen Rückstroms zum Herzen [Death due to unusual position of the body – an explanation for the consequence of reduced venous reflux to the heart]. Arch Kriminol. 2004;213(3-4):102-107.
[6] Byard RW, Wick R, Gilbert JD. Conditions and circumstances predisposing to death from positional asphyxia in adults. J Forensic Leg Med. 2008;15(7):415-9. [DOI: 10.1016/j.jflm.2008.01.001]
[7] Yee T, Gronner A, Knight RT. CT findings of hypoxic basal ganglia damage. South Med J. 1994;87(6):624-6. [DOI: 10.1097/00007611-199406000-00009]
[8] Tippin J, Adams HP Jr, Smoker WR. Early computed tomographic abnormalities following profound cerebral hypoxia. Arch Neurol. 1984;41(10):1098-100. [DOI: 10.1001/archneur.1984.04050210100024]
[9] Belviso M, De Donno A, Vitale L, Introna F Jr. Positional asphyxia: reflection on 2 cases. Am J Forensic Med Pathol. 2003;24(3):292-7. [DOI: 10.1097/01.paf.0000083226.41296.ce]
[10] Sertaridou E, Papaioannou V, Kouliatsis G, Theodorou V, Pneumatikos I. Traumatic asphyxia due to blunt chest trauma: a case report and literature review. J Med Case Rep. 2012;6:257. [DOI: 10.1186/1752-1947-6-257]
[11] D’Elia F, Simonit F, Desinan L. A case of complex asphyxia sheds light on problems in the classification of asphyxias. Leg Med (Tokyo). 2024;66:102368. [DOI: 10.1016/j.legalmed.2023.102368]
[12] Byard RW. Issues in the classification and pathological diagnosis of asphyxia. Aust J Forensic Sci. 2011;43(1):27-38. [DOI: 10.1080/00450618.2010.482107]
[13] Tejaswi KB, Hari EA. Virtopsy (virtual autopsy): A new phase in forensic investigation. J Forensic Dent Sci. 2013;5(2):146-8. [DOI: 10.4103/0975-1475.119777]
[14] Tattoli L, Melloni ND, Di Vella G. Positional asphyxia in a work-related fatality. Forensic Sci Med Pathol. 2019;15(4):642-5. [DOI: 10.1007/s12024-019-00119-0]
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