The American Journal of Forensic Medicine and Pathology

22(2):139149, 2001.

2001 Lippincott Williams & Wilkins, Inc., Philadelphia

Morphologic Determinants of Asphyxia in Lungs

A Semiquantitative Study in Forensic Autopsies

Carlos Delmonte, M.D., Ph.D., and Vera Luiza Capelozzi, M.D., Ph.D.

In biologic systems, the extent and type of pathologic and toxicologic findings can often be correlated with the specific circumstances of the fatal
event. While such correlations are never perfect,
their use in forensic scientific investigations forms
an important component of the experienced investigators repertoire. In addition, enlightened interpretation of postmortem findings may assist in elucidating the circumstances of death when they either
are unresolved or later are found to have been confabulated.
Deaths resulting from violent asphyxia demonstrate a relative scarcity of histopathologic findings
(1). Nevertheless, it is important to document the
pathologic changes in such cases to exclude other
forms of trauma or other modes of death that may
denote murder made to appear as suicide or natural
death.
In addition, it appears to us that subtle differences in the particular constellation of histopathologic changes within the asphyxia death category
may reflect how death occurred, through a gradation and quantitation of pathophysiologic alterations based on both the rapidity of compromise of
the respiratory tract and its degree of completeness.
Asphyxia is a name given to different kinds of lesions that can produce similar histopathologic findings (28).
Thus, because of the varied nature of the different kinds of lesions, as well as the incidence
of similar qualitative histologic findings with different causes, the aim of this work was to determine semiquantitative morphologic parameters in
previous demographic and circumstantial data in
167 consecutive asphyxia deaths by aspiration,
suffocation, drowning, and strangulation investigated by the Forensic Institute of Medicine in
So Paulo.

Asphyxia is a name given to different kinds of lesions

that can produce similar histologic findings. Thus, because of the varied nature of the different kinds of lesions, as well as the incidence of similar qualitative histologic findings with different causes, the aim of this
work was to study special kinds of injuries with particular subsequent impairment. These include some diagnostic problems of sudden death of natural causes, including
aspiration, suffocation, drowning, and strangulation.
Ranking was made of 167 victims based on the diagnosis as having: aspiration (n  35), suffocation (n  88),
drowning (n  27), and strangulation (n  17). Stepwise
discriminant analysis of the resulting data showed that
lung necropsies from victims of these four events could
be distinguished from one another. Statistical differences
among the four groups were observed for eight morphologic parameters. A robust discriminant function permitted an adequate classification of the four groups of
disease in 85.03% of the cases. Lung autopsies with
congestion, septal hemorrhage, and foreign body showed
a specificity of 100% for victims of aspiration, whereas
ductal overinsufflation, interstitial edema, and bronchiolar constriction showed a specificity of 81.8% in victims
of suffocation. Intraalveolar edema and dilatation of the
alveolar spaces with secondary compression of the septal capillaries characterized drowning. Victims of strangulation showed a strong alveolar hemorrhage, with
alveolar collapse and overinsufflation, associated with
bronchiolar dilatation. It is concluded that semiquantitative analysis of lung autopsies might be a useful supplementary histologic criterion to support the diagnosis of
asphyxia.
Key Words: AsphyxiaSemiquantitative analysis
Pathology.

Manuscript received June 1, 2000; accepted June 8, 2000.

From the Forensic Institute of Medicine (C.D.) and Department of Pathology (V.L.C.), University of So Paulo School of
Medicine, So Paulo, Brazil.
Supported by the Brazilian Funding Agencies FAPESP,
CAPES, CNPq, and LIM-HCFMUSP.
Address correspondence and reprint requests to Vera Luiza
Capelozzi, Departamento de Patologia, Faculdade de Medicina
da USP, Av. Dr. Arnaldo 455, CEP 01246-009, So Paulo, SP.,
Brasil.

139

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C. DELMONTE AND V. L. CAPELOZZI

METHODS

Demographic and Situational Data

The deaths included in this study consisted of 200
cases consecutively investigated from 1996 to 1998
by the Forensic Institute of Medicine. A complete
postmortem examination was conducted in each
case, either personally performed or individually supervised by the main author. Those few cases that
demonstrated putrefactive changes so severe that adequate interpretation of postmortem findings was
compromised were excluded from the study. Before
the project was begun, a data protocol was prepared
that included certain personal, demographic, circumstantial, and pathologic information. The prosecutor in each case completed the protocol.
Regarding definition of terms, characterization of
cases was made according to a previous consensus
that asphyxia in a forensic context is mechanical
asphyxia, rather then some of the internal conditions, which are more likely to arise as a result of
natural disease or toxic conditions. Several different names have been used to describe the various
types of asphyxia. Because some of them are confusing or inexact, they were characterized as follows (4,5):
Aspiration: blockage of the airways by a foreign
body.
Suffocation: failure of blood oxygenation caused
by entrapment or environmental suffocation,
smothering, choking, mechanical asphyxia, or
mechanical asphyxia combined with smothering
and suffocating gases.
Drowning: death occurring after immersion in
water.
Strangulation: a form of compression of the neck
for hanging and ligature or manual strangulation.
The cases were divided into four groups: group I,
aspiration (n  35); group II, suffocation (n  88);
group III, drowning (n  27); and group IV, strangulation (n  17). The diagnosis was based on
legal expertise. In each case, data concerning the
victims age and sex, as well as the circumstances
of death, are reported (Table 1).

Technical Procedures to Obtain the Lungs

The necroscopic examination was done according to the routine procedure established by the
Thanatology and Forensic Pathology Department
of the Legal Medicine Institute of So Paulo.
Briefly, the thoracotomy was done in the anterior
medial line by sternopubic incision. The heart was
removed by transection of the aortic and pulmonary
vessels and the vena cava and pulmonary veins.
The lungs were obtained by transection of the trachea 5 cm above the carina. After that, they were
cut into 1-cm parasagittal slices, carefully examined for the presence of gross abnormalities, and
fixed with 15% formalin solution for 24 hours. To
avoid suspicion of respiratory hazards other than
asphyxia, 33 of the 200 lungs collected were excluded because macroscopic and microscopic examinations of fixed lung slices indicated severe
chronic bronchitis and/or emphysema and were obtained from older patients who were smokers (median age 54 years). Two or three sections of distal
parenchyma (right middle lobe) were embedded in
paraffin and processed according to conventional
histologic procedures for optical microscopy. In
fact, rather than the entire lung, the middle lobe
was chosen because it is prone to have minor degrees of postmortem blood stagnation.
Slides 5 m thick were taken and stained with
hematoxylin and eosin. All slides were coded, randomized, and then evaluated by a single observer
who did not have access to the code.
Morphologic Study
Qualitative Analysis
The histologic sections obtained for each case
were first examined qualitatively to determine pulmonary architecture alterations and histopathologic
lesions. In this way, the pulmonary tissue was divided into two histoanatomic compartments: the
lobular compartment, represented by the membranous bronchioles, and the acinar compartment, represented by the respiratory bronchioles and the adjacent alveolar tissue (ducts, sacs, and alveoli). In

TABLE 1. Summary of cases and circumstances of death

Category
Age (yrs)
Sex (no.)
M
F
Cause of asphyxia
Accidental (no.)
Suicidal (no.)
Homicidal (no.)

Aspiration (n  35)

Suffocation (n  88)

Drowning (n  27)

Strangulation (n  17)

030

10 days42

364

979

18
17
Amniotic fluid, milk, gastric content
35
0
0

65
23
Pillow, hands, other
84
0
4

23
4
Water
27
0
0

17
0
Rope or similar device
0
14
3

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ASPHYXIA IN LUNGS
all cases, histologic analysis of the pulmonary architecture showed the following alterations:
Alveolar tissue collapse was characterized at
low magnification by collapse of the alveolar
framework, involving alveolar sacs and ducts
leading to overlap of the alveolar septa and reduction of the space for gas exchange. Figure 1
shows the histopathologic picture after the alveolar collapse.
Alveolar tissue overinsufflation was revealed at
low magnification by heterogeneous enlargement of the ducts, sacs, and alveoli, contrasting
with the adjacent collapsed areas. Figure 1 and
Figure 2A through F show the spatial arrangement of the alveolar tissue after overinsufflation.
Bronchiolar constriction was characterized by luminal reduction of the membranous and respiratory bronchioles, enhanced by the virtual increase
in the thickness of muscle layer and epithelium
corrugation. Figure 2H shows a typical case.
Bronchiolar dilatation was shown by the increase of internal diameter of the membranous
and respiratory bronchioles and consequent thinning wall (Fig. 2G).
Then, each histoanatomic compartment was examined for histopathologic lesions according to the
basic principles of general pathology: cell injury, inflammation/repair, and circulatory alterations. Thus,
the histopathologic lesions in each case examined
constituted a morphologic substrate of general pathologic changes related to the circulatory alterations,
specifically edema, intraalveolar deposition of pro-

141

teic and amorphous material, passive congestion,

and hemorrhage, characterized as follow:
Edema was recorded when proteic, amorphous,
eosinophilic material was present inside the
alveolar septa (Fig. 1D).
Intraalveolar deposition of proteic and amorphous material was observed in two situations.
In the first, the amorphous material filled the
alveolar spaces in a uniform and homogeneous
pattern similar to that of hydrostatic edema,
characterizing the near-edema seen in Figure 3A
and B. In the second, the presence of a heterogeneous and lightly basophilic material (Fig.
4C,D) filling the alveolar spaces characterized
the presence of a foreign body (milk, amniotic
fluid).
Passive congestion was the anatomic substrate of
the venous stasis in the pulmonary microcirculation. It was characterized by capillary distention,
in which dilatation and sinuosity caused a spatial
distortion of the alveoli, thereby being responsible for the increased color features observed in
the tissue at optical microscopy (Fig. 4A,B).
Hemorrhage was characterized by the presence
of blood inside the alveolar spaces (Fig. 2A,B)
or along the alveolar septa (Fig. 4E,F); in both
situations, the background structures were
blurred.
Quantitative Analysis
Because the qualitative study revealed common
morphologic parameters for the four groups of asphyxia, the next procedure included the semiquan-

FIG. 1. Lung parenchyma in

asphyxia by suffocation. (A
D) Alternating zones of ductal overinsufflation (ov) and
alveolar collapse (col) of the
lung parenchyma in suffocation cases. (B,D) Characteristic interstitial edema (ed).

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C. DELMONTE AND V. L. CAPELOZZI

FIG. 2. Lung parenchyma in strangulation

(suicidal hanging and homicidal ligature
strangulation). (A,B) Intraalveolar hemorrhage (hem). (CF) Alternating areas of
alveolar collapse (col) and overinsufflation
(ov). (G,H) Zones of bronchiolar constriction (brc) and dilatation (brd), a characteristic morphologic picture in this group.

titative analysis of the previous parameters established, as follows:

Parameters related to pulmonary architecture
Alveolar tissue collapse
Alveolar tissue overinsufflation (alveolus and
ducts)
Bronchiolar constriction (membranous and
respiratory bronchioles)
Bronchiolar dilatation (membranous and respiratory bronchioles)
Parameters related to histopathologic lesions
Interstitial edema
Intraalveolar deposition of proteic and amorphous material (near-edema, foreign body)
Passive congestion
Hemorrhage (intraalveolar and interstitial)
These parameters were semiquantified by a
histopathologic score according to the extent and
Am J Forensic Med Pathol, Vol. 22, No. 2, June 2001

severity of the histopathologic lesions present in

total tissue, examined as follows:
0: Absence of lesion
1: Presence of lesions
2: Presence of lesions
3: Presence of lesions
4: Presence of lesions

in
in
in
in

1% to 25%
26% to 50%
51% to 75%
76% to 100%

Statistical Analysis
Discriminant analysis was used to obtain a statistical classification of the four groups. This
method permits finding the linear/additive combination of variables that gives the clearest separation
of individuals into different groups. It includes
identification of the variables that contribute significantly to discrimination. The criterion for inclusion of a variable was an F value of 3.0, roughly
corresponding to P  .04. Further independent

ASPHYXIA IN LUNGS

143

FIG. 3. Lung parenchyma in

drowning cases. (A) Panoramic view of intraalveolar
deposition of proteic and
amorphous material (am).
(B) High-magnification view
showing acute dilatation of
the alveoli with extension,
elongation, and thinning of
the septa and compression
of the alveolar capillaries by
a prominent intraalveolar reddish liquid similar to edema
(am).

combinations of the same variables were also calculated. Classification involves determining a separate prediction equation corresponding to each
group that gives the probability of belonging to
that group. A stepwise procedure was used to select the variables relevant to distinguishing the
groups. Because the discriminant power would be
optimistic when assessed on the same data used to
derive the functions, a jackknife (one-out) procedure was included in the results. In short, this procedure withdraws one victim (victim 1, for instance) from the analysis, then the model is
reestimated excluding that victim. Afterward, the
excluded victim is classified according to the new
model, and his or her actual classification is compared with that predicted. Next, victim 1 is again

included in the analysis and victim 2 is withdrawn,

according to the same procedure, until calculations
are completed for all victims included in the study.
All statistical procedures were done by use of the
SPPS (version 6.0) statistical package (9), and the
level of significance was 0.5%.
RESULTS
Individual Morphometric Measurements
Figures 5 through 7 show the morphometric data
for the 167 serial autopsies. Alveolar hemorrhage
(Fig. 7A), congestion (Fig. 5A), alveolar collapse
(Fig. 7B), alveolar overinsufflation (Fig. 7C), bronchiolar constriction (Fig. 6B), and bronchiolar dilatation (Fig. 8D) were higher in strangulation,
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C. DELMONTE AND V. L. CAPELOZZI

FIG. 4. Lung parenchyma in

aspiration cases.(AD) Characteristic histologic appearance of congestion areas
(cong) and engorged capillaries protruding into the
alveolar lumen (arrows), as
well as the foreign body occupying the bronchiolar and
alveolar
lumen
(arrowheads). (E,F) Septal hemorrhage (double arrows), a
typical morphologic reaction
finding in this.

whereas septal hemorrhage (Fig. 5C) and foreign

body (Fig. 5B) were more frequent in aspiration.
Intraalveolar edema (Fig. 6C) and ductal overinsufflation (Fig. 6A) with interstitial edema (Fig. 6D)
characterized drowning and suffocation, respectively.
Statistical Analysis
Different combinations of the morphometric data
by discriminant analysis selected eight variables capable of distinguishing the groups. These are given
here, with P values relating to removal from the
model: septal hemorrhage (P  .001), foreign body
(P  0.001), alveolar hemorrhage (P  .001),
bronchiolar dilatation (P  .001), edema (P 
.001), bronchiolar constriction (P  .001), ductal
overinsufflation (P  .001), and alveolar collapse
(P  .001). These relevant variables were used to
construct the model shown in Figure 8, where a
plot of the values of the first two linear discriminant
functions for each individual nearly shows the separation achieved between the groups. The solution
generated by discriminant analysis allowed us to
Am J Forensic Med Pathol, Vol. 22, No. 2, June 2001

distinguish four distinct patterns of asphyxia: aspiration, suffocation, drowning, and strangulation.
Aspiration
In this pattern, extension of the area occupied by
congestion (Fig. 4AD) and septal hemorrhage (Fig.
4E,F) was significantly higher in aspiration. In addition, and as expected, in these groups semiquantitative analysis of a foreign body (Fig. 4C,D) was statistically higher in aspiration than in the other
groups. Congestion and hemorrhage allowed a distinctive histologic pattern to be highly associated
with a diagnosis of aspiration, in which a septal hemorrhage was the typical morphologic reaction
(Fig. 4E,F). In addition to this picture of hemorrhage, there was considerable foreign body occupation of the lumen of the bronchioles and alveoli (Fig.
4C,D). Thirty aspiration victims (100%) were properly classified as having aspiration (Table 2).
Suffocation
In the second pattern of asphyxia, the extension
of the area occupied by ductal overinsufflation (Fig.

ASPHYXIA IN LUNGS

145

FIG. 5. Extension area (%) of congestion (A),

foreign body (B), and septal hemorrhage (C) in
the four groups.

FIG. 6. Extension areas (%) of ductal overinsufflation (A), bronchiolar constriction (B), intraalveolar edema
(C), and interstitial edema (D) in the four groups.
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C. DELMONTE AND V. L. CAPELOZZI

FIG. 7. Extension areas (%) of alveolar hemorrhage (A), alveolar collapse (B), alveolar overinsufflation (C),
and bronchiolar dilatation (D) in the four groups.

1) and interstitial edema (Fig. 1B,C) were statistically more frequent in suffocation than in drowning
or strangulation. Here, there was no interstitial
edema, and the ductal overinsufflation was present
in a minor degree. In suffocation cases, equally
present but in a minor degree were the alternating
zones of alveolar overinsufflation and collapse.
Bronchiolar constriction was present in both suffo-

cation and strangulation, whereas intraalveolar

edema was a common parameter between suffocation and drowning cases. However, ductal overinsufflation in the form of acute substantial emphysema was characteristically present in most cases of
death by suffocation. Seventy-two (81.8%) of the
88 victims of suffocation elsewhere were properly
classified in the group in which the cause of the

FIG. 8. The results of stepwise discriminant analysis.

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147

TABLE 2. Cases correctly classified by the model (incorporating jackknife)

Predicted group membership: No. (%)
Actual Groups
Group 1
Group 2
Group 3
Group 4
TOTAL

No. of cases
35
88
27
17
167

1
35 (100)
0 (0)
2 (7.4)
0 (0.0)

death was associated with suffocation. Sixteen patients of this group were misclassified (Table 2) and
fell into the group of drowning by strangulation.
Drowning
In the third pattern of asphyxia, extension of the
area occupied by intraalveolar deposition of proteic
and amorphous material (Fig. 3A,B) was the semiquantitative parameter statistically associated with
drowning. The other parameters, although still present, were not as statistically significant in drowning
as the edema was.
Strangulation
The extension of the area occupied by alveolar
hemorrhage (Fig. 2A,B) was significantly higher in
lungs associated with strangulation. Equally significant was the association of alveolar collapse (Fig.
2B,C), alveolar overinsufflation (Fig. 2E,F), and alternating zones of bronchiolar constriction and
bronchiolar dilatation (Fig. 2G,H). This particular
morphologic picture thus characterized the lung involvement in the fourth group of asphyxia.
DISCUSSION
Asphyxia can be defined as the injuries caused by
oxygen deficiency (hypoxia) that involve all conditions and sequelae caused by impairment or interruption of the oxygen supply or utilization in the
tissues. Conversely, the term suffocation in forensic
medical usage is restricted, for practical purposes,
to cases in which environmental suffocation (inadequate oxygen in the atmosphere due to environmental conditions), smothering (due to mechanical
obstruction of the nose and mouth), choking (due to
blockage of the internal airways), and mechanical
(due to pressure on the chest). In forensic practice,
the recognition of death through asphyxiation can
present problems if there are no indicative external
or internal injuries or obstruction of the respiratory
tract, and the conditions of death are not known in
detail. In addition, the known macroscopic and histologic signs of general damage through hypoxia,
e.g., edema, hemorrhage, pulmonary emphysema,

0 (0.0)
72 (81.8)
6 (22.2)
1 (5.9)
(85.03)

0 (0.0)
13 (14.8)
19 (70.4)
0 (0.0)

0 (0.0)
3 (3.4)
0 (0.0)
16 (94.1)

passive congestion, and degenerative cellular

changes, are usually diverse and are not conclusive
as individual findings (1011). Similar findings can
also arise through injuries leading to impairment of
the circulation, or ischemia, thereby reducing or interrupting the tissue oxygen supplies. The extent of
terminal hypoxia is also relevant to the postmortem
detectable changes (12). Therefore, the differential
diagnosis of asphyxia has been limited by the qualitative similarity of the gross and histopathologic
features in pulmonary involvement. In the absence
of specific criteria, interpretation of a morphologic
picture in asphyxia challenges the pathologist
mainly when the same morphologic parameter is a
common feature among the cases.
In this work, qualitative study revealed common
morphologic parameters for the four groups of asphyxia. In all cases histologically analyzed, the pulmonary architecture showed variables in the degree
of alveolar tissue collapse, overinsufflation, bronchiolar constriction, and dilatation. Equally common among the four groups were the histopathologic lesions: edema, intraalveolar deposition of
proteic and amorphous material, passive congestion, and hemorrhage. However, we have shown
that by means of a simple and quick semiquantitative method, with no additional cost to the Forensic
Institute, it is possible to further characterize four
specific groups of asphyxia and to suggest a specific diagnosis with reasonable accuracy. The
method also allowed obtaining complementary parameters to refuse natural causes of death. Analysis
of the results allowed us to identify four distinct
patterns of histologic lung involvement.
As aspiration lung was characterized by gastric
content or amniotic fluid, partially or totally filling
the bronchiolar lumen and the alveolar spaces, thus
characterizing the foreign material aspirated. As a
consequence, occlusion of the small airways, mainly
the membranous and respiratory bronchioles, was a
typical morphologic finding. This pattern of bronchiolar involvement was not uniform along the
small airways and was in contrast to areas where
bronchiolar constriction was also evident. Thus, the
simultaneous occurrence of acute and vicarious
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C. DELMONTE AND V. L. CAPELOZZI

emphysema, characterized by alternating areas of

overinsufflated and collapsed alveoli, was evident.
This morphologic disarrangement of the bronchiolar
and alveolar architecture determines changes in the
ventilation/perfusion relationship leading to acute
vascular congestion and engorged capillaries protruding into the alveolar space, making recognition
of the alveolar boundaries particularly difficult. In
addition, septal hemorrhage was also evident. In
these cases, differential diagnosis between intrapulmonary hemorrhages of various causes, such as
hemorrhagic pulmonary edema and hemorrhagic
pulmonary infarctions or pneumonia, may be possible by complementary findings, such as bronchiolar
constriction in cases of acute aspiration.
An acutely asphyxiated lung, characterized by
acute substantial emphysema (ductal overinsufflation), was the typical morphologic reaction seen in
the lungs of victims of suffocation. Pathology panel
members who studied the prevalence of histologic
lesions in sudden infant death syndrome (13) obtained similar findings. These findings are opposite
those of Simonin and colleagues (7), who reported
that in death caused by suffocation, the cause of
death could not be determined by autopsy alone because there were no specific findings. Another differential parameter in our cases of suffocated lungs
was interstitial edema secondary to hypoxia. These
findings are supported by animal experiments with
asphyxiated lung (10,1415), where the more frequently occurring pulmonary edema following hypoxia was attributed to the physiologically greater
permeability of the capillaries in the lungs under
conditions of hypoxia.
In the third pattern of lung involvement, the use
of semiquantitative information, besides improving the morphologic characterization of drowned
lung, led to the identification of victims that
should continue under diagnostic investigation. As
shown in Table 2, the discriminant model misclassifies mainly the groups involving drowning and
suffocation. In this work, fresh-water drowned
lung was characterized by acute dilatation of the
alveoli with extension, elongation, and thinning of
the septa and compression of the alveolar capillaries by a prominent intraalveolar intense rose-colored liquid similar to edema. Reidbord and Spitz
(16) and Spitz et al. (17) described similar findings in victims drowning in fresh water, and unlike the findings of Knight (5), these positive
signs of drowning were not scanty and nonspecific. The histopathologic picture of intraalveolar
deposition of proteic and amorphous material
(near-edema) found in fresh-water drowned lung
has strong support in experimental studies on rats
Am J Forensic Med Pathol, Vol. 22, No. 2, June 2001

involving active aspiration of watery liquids of

various osmolarities (18). The pathophysiologic
mechanism involves general hyperhydration of the
submicroscopic cell organelles, as mitochondria
and endoplasmic reticulum, which in turn brings
about swelling and the intracytoplasmic vesicular
formation of pneumocytes and capillary endothelia
(10,18).
In the fourth group of asphyxia, strangulation,
alternating areas of bronchiolar constriction and dilatation leading to alveolar collapse and overinsufflation, associated with a picture of alveolar hemorrhage, were the morphologic characteristics of lung
involvement. These disturbed morphologic disarrangements of the bronchiolar and alveolar architecture determine changes in the circulation relationship leading to a particular reaction patternthe
alveolar hemorrhagewhich enabled them to be
distinguished from other forms of death. Accordingly, specific morphologic changes can be also expected in the parenchyma of the lungs in experimental cases of strangulation. In fact, rats and
rabbits, with appropriate controls, showed a pronounced hemorrhagic syndrome, extending to all
compartments of the lungs, to be a qualitatively and
quantitatively prominent finding in strangulation.
By means of semithin sections and electron microscopy, a distinct alveolar hemorrhage was also
demonstrated that did not occur in other forms of
death with short agony (11). The pulmonary vascular system and pulmonary tissues thus constitute a
target organ of strangulation agony (11,18). The
Hamburg working group around Brinkmann (11)
has systematically studied the pathophysiologic
processes that occur in the pulmonary vascular system and pulmonary tissue during strangulation. The
object of these animal experiments and comparative pathologic studies in humans was the compilation of findings utilizing histopathologic staining
methods and forensic-medical assessments. Further
investigations concerning these problems involve
the frequency of pulmonary hemorrhage in death
by strangulation (19) and the question of acute emphysema in strangulation (20).
We conclude that semiquantitative analysis of
lungs at autopsy can be useful as a supplementary
histologic criterion to support the diagnosis of asphyxia. The discriminant parameters obtained
proper permitted classification in 85.03% of cases.
This finding suggests that additional studies, including macroscopic characteristics, clinical data,
and electron microscopy techniques, are probably
required for better identification of asphyxia. However, because of its simplicity, efficiency, and low
cost, the use of morphometric tools in the routine

ASPHYXIA IN LUNGS
procedures should be encouraged in the analysis of
death by asphyxia.
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