Hemorrhages in the root of the tongue have been considered to be a finding associated with asphyxiation. The aim of the present study was to examine the incidence and diagnostic value of the lingual hemorrhages in fire fatalities with reference to the related pathological and toxicological findings, in comparison with asphyxiation and drowning cases. In fire fatalities (n = 90), small to marked hemorrhages were observed in 26 cases (28.9%). In the reference groups (asphyxiation and drowning), the hemorrhages were frequently observed in ligature strangulation (n = 10/15), manual strangulation (n = 5/7) and traumatic asphyxia (n = 4/5). In fire fatalities, the hemorrhages were closely associated with a lower blood carboxyhemoglobin (COHb) level, suggesting an influence of fatal burns: n = 16/32 (50.0%), n = 8/26 (30.8%) and n = 2/32 (6.2%), respectively, in cases of COHb < 30%, 30-60% and > 60%. These findings suggested possible acute hemodynamic disturbance in the head including brain (cranial congestion) in the dying process due to fires. A careful differentiation from neck compression may be necessary in such cases.
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