Electrocution Stigmas in Organ Damage: The Pathological Marks

Abstract

Background: Diagnostic criteria for electrocution related death are still a challenge in forensic pathology and it seems that the electrical mark is the only reliable evidence.

Methods: A comparison of histological and morphological findings of skin and internal organs from an autopsy series of electrocution deaths with those mostly reported in literature as representative for electrocution.

Results: The morphological changes of heart, brain and other main internal organs are still unspecific. Organ's damage observed in electrocution deaths shows a wide variability, not reliable for a certain diagnosis of electrocution. The electrical mark is still the golden standard for diagnosis of electrocution.

Conclusions: In electrocution related deaths, pathological findings of the main internal organs are not enough evidence to support with certainty a post-mortem diagnosis that a victim suffered an electrical damage. Although the organ histological changes are undoubtedly the starting point for a better understanding of the fatal even, the diagnosis of death from electrical damage is still a dark and unsolved chapter. The electrical mark still represents a fundamental indicator above all in the medical-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases.

Keywords: autopsy; brain; electrocution; heart; histology; lung; rhabdomyolysis; skin.

Figure 1

Macroscopic findings. Electrical lesions on the right palm (A insert) from low voltage; electric lesion of the dorsal face of the second finger on the left hand from high voltage (B).

Figure 2

Skin histology from low and high voltage electrocution. (A–D): comparison of two cases of low (A–C) and high voltage (B–D) electrocution respectively with preserved basal epithelial layer in (A) (box indicates the detail) and dermal-epidermal detachment loss in (B) (box indicates the detail) (H&E stain ×20). In (C) black arrow indicates the presence of epidermal basal layer (H&E stain × 40), while in (D) loss of basal epidermal layer (H&E stain × 40).

Figure 3

Brain histology from high voltage electrocution death. (A,B): massive cerebellar and brain hemorrhage respectively (blue box indicates the detail) with intra-vessel coagulopathy in (B) (black arrow indicates the detail) (H&E stain ×10 A; ×20 B). (C): dark neurons as sign of ischemic neuronal damage due to vasoconstriction (H&E stain ×20). (D): axonal balloon degeneration (blue box indicates the detail) in a context of white matter necrosis and degeneration (H&E stain ×40).

Figure 4

The heart and lung histology from high voltage electrocution. Different localizations of necrosis. (A,B): multiple and diffuse foci in the absence of inflammatory infiltrate (blue box indicates the detail) with erythrocyte extravasation (black arrow indicates the detail) (H&E stain ×10 in A, ×40 in B). (C,D): large areas of coagulative necrosis with loss of nuclei and with erythrocyte extravasation in (C) (blue box indicates the detail) (H&E stain ×10). (E): fragmentation of myofibers with enlarged and distorted nuclei (blue box indicate the detail) (H&E stain ×40). (F): pulmonary intra-alveolar edema and hemorrhage (black arrow indicates the detail) (H&E stain ×10).

Figure 5

Tetanization-induced rhabdomyolysis. Fragmented striated muscle fibers with necrosis and erythrocytes (blue box indicates the detail) (H&E stain ×63).