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Abstract
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The presence of petechiae of the face and conjunctiva is a well-described finding seen in strangulation injuries. These petechiae are commonly seen post-mortem in deaths by asphyxia and are consequently used in forensic analysis.
Conjunctival and facial petechiae have also been noted to occur in nonfatal asphyxia, and their presence may be a sign that a severe strangulation injury has occurred.
The mechanism for facial and conjunctival petechial hemorrhages in asphyxia is thought to be rupture of capillaries with little connective tissue support secondary to local pressure elevation from continued arterial flow while venous output is obstructed.
We herein report an unusual case of a pediatric patient in which this clinical presentation signaled underlying recreational self-inflicted strangulation. This case report is adherent to the principles of the Declaration of Helsinki and is compliant with Health Insurance Portability and Accountability Act guidelines.
A 13-year-old girl presented with conjunctival and periorbital petechiae, noticed several hours earlier. She denied change in vision, eye pain, nosebleeds, or easy bruising. She had a history of chronic constipation but no recent infections, weight change, or fever and no family history of bleeding disorders. When interviewed in private, the patient disclosed a history of substance use (including inhalants, benzodiazepines, and marijuana), psychiatric illness (including recent hospitalization for intentional overdose), and self-injurious behavior. The patient also disclosed self-inflicted strangulation to "[get] high," which she had been participating in over the last year. She denied recent suicidal thoughts and current participation in self-harm activities. However, based on her affect it was not clear to examining providers if she was fully forthcoming about her recent behavior, and suspicion for ongoing participation in self-inflicted strangulation remained...
Language: en |