Heamatoma of thigh

black eye

• Contusion indicates trauma. 

• Gives a clue about the time of trauma. 

            1.                    2.      

                ? When did above contusions have taken place   

• In certain circumstances the sequential color changes do not occur with healing.

                    e.g. - Subconjunctival contusions

                                                                            ? Why

                              - Color changes is delayed in elderly, malnourished, obese, chronic debilitating diseases.

• Pattern of contusions may indicate the type of trauma.

 e.g. multiple contusions of different ages indicate repeated trauma - physical child abuse or domestic violence.

• Scalp contusions are better felt than seen.         ? Why

              Arrow shows  a scalp contusion from inner aspect of the scalp

• If more than 35% of the area of the body is contused, it may cause death.

• Contusions may appear some time after trauma. Therefore may not be visible on first examination.

           If suspected

                        - review a patient after sometime

                        - examine a dead body for the second time 24 to 48 hours after the first examination

                        - examine by ultra violet light

                        - special autopsy dissection techniques  - specially on alleged victims of torture in order to identify deep contusions

    Deep contusions are demonstrated by a deep cut of the back of the leg in a tortured victim

• Contusions may appear in a place away from the site of trauma.

      e.g. blow to frontal area of head -  peri-orbital contusion

             blow to arm & thigh  - contusion around elbow & knee

          

periorbital contusion

• The size of a contusion does not indicate the the strength of the force.

       This is because there are other factors which affect the size of a contusion.  

• The appearance of a contusion will depend on several factors . 

• The shape of a contusion may indicate the offending weapon.

• 'Patterned contusions' in road traffic accident

? what is the the causative agent here

• 'Tram line' contusion in assault

? Causative agents and the mechanism of trauma

• 'Discoid contusions'

 caused by finger pulp

• suction bruises by the lips (see below)

• Distribution of contusions may indicate the circumstances of assault.

    e.g. Discoid contusions around the mouth suggest smothering

          Discoid contusions around the neck suggest manual strangulation

          Suctions bruises around genitals and breast indicate sexual assault

                                              Suction bruises of the breast

• Postmortem contusions are rare as a large force is required to cause a postmortem contusion

       e.g. falling of the body from a trolley, dashes against rocks by the waves, rough handling of the body (evisceration leading to rupture of pharyngo-esophageal plexuses)

• Postmortem changes and other features may mimic contusions

        - hypostasis externally or internally

        - decomposition

        - pigments

        - birth marks

? Differences between contusions and hypostasis