SHORT REPORT Diagnostic issues in unusual asphyxial deaths R. W. Byard, 1 D. Williams, 2 R. A. James, 1 J. D. Gilbert 1 1 Forensic Science Centre, Adelaide, South Australia; John Tonge Centre, Brisbane, Queensland, Australia, 2 John Tonge Centre, Brisbane, Australia SUMMARY. Upper airway occlusion may be due to a variety of causes and may result from accidents, suicides or homicides. Underlying natural diseases may also predispose to lethal choking episodes. A series of nine cases is reported to illustrate a range of circumstances that resulted in fatal upper airway compromise. These included suicide from upper airway obstruction due to an impacted blanket, and accidental deaths due to inhalation of soil, a rock, and a video cassette sticker. One death resulted from glottic obstruction due to a mucosal cavernous haemangioma, another from an enlarged tonsil, and two deaths were precipitated by underlying organic disease in the form of dementia and insulin-dependent diabetes mellitus. The manner of death was not clear cut in two cases where there was evidence of possible accidental death or suicide. ß APS/Harcourt Publishers Ltd 2001 Journal of Clinical Forensic Medicine (2001) 8, 214±217 INTRODUCTION Upperairwayobstructionmayoccurfromavarietyof different causes, the most common being self-in¯icted hanging in suicides and accidental choking on food in individuals with dementia. 1,2 The following series of cases is described to demonstrate a variety of different circumstances that led to death from asphyxia, with an analysis of predisposing factors and discussion of problems that may occur in determining the manner of death. CASE REPORTS Case 1 A 53-year-old schizophrenic male had been admitted to a psychiatric facility following attempted suicide by drug overdose. He was subsequently found dead with a blanket inserted into his mouth and pharynx. The blanket was removed during attempted resuscitation. At autopsy there was no evidence of signi®cant injury or natural disease. Toxicology revealed only thera- peutic levels of a variety of standard psychothera- peutic agents including haloperidol, carbamazepine and olanzapine. Death was due to suicide by upper airway obstruction from a blanket. Case 2 A58-year-oldmalewasfounddeadinhisprisoncellin a kneeling position hanging from a knotted sheet looped over a bookshelf. Towel padding was present aroundtheneck.Thebodywasnakedandabodyform had been constructed out of blankets and a pillow in the bed (Fig. 1). No suicide note was present and the deceasedwasnotonantidepressantmedication.There was no pornographic material or evidence of recent sexual activity. At autopsy there were no facial or conjunctival petechiae. The left superior horn of the thyroid cartilage was fractured. Apart from this, and the ligature mark around the neck, there was no evi- dence of injury. There was no signi®cant natural dis- ease. Postmortem toxicology was negative. Death was due to hanging. Case 3 A 24-year-old male was found dead under his carport. Insidethehousealaundrytroughwas®lledwithwater within which was a hairdryer connected to the mains. R. W. Byard, R. A. James, J. D. Gilbert, Forensic Science Centre, 21 Divett Place, Adelaide 5000, Australia. D. Williams, James Tonge Centre, Brisbane, Australia Correspondence to: Professor Roger W. Byard, Tel.:  618 8226 7700; Fax: 618 8226 7777; E-mail: byard.roger@saugov.sa.gov.au Journal of Clinical Forensic Medicine (2001) 8, 214±217 ß APS/Harcourt Publishers Ltd 2001 doi: 10.1054/jcfm.2001.0524, available online at http://www.idealibrary.com on 214