Suicidal hanging resulting in decapitation is rarely documented. This discussion involves a case of a 35-year-old man found decapitated in his residence's garden. A systematic literature review on hanging-induced decapitation was conducted to comprehensively investigate and compare the case to existing literature. The study aims to identify frequently described post-mortem findings in cases of suicidal hanging leading to decapitation. A 35-year-old man was found decapitated in his garden, with a jute strap and chimney debris nearby. The cervical region was completely severed along the dorsoventral and craniocaudal plane, exposing internal structures. A ligature mark was present, along with Amussat's sign and Simon's bleeding. The systematic review of the literature followed PRISMA standards, analyzing 3622 publications from Google Scholar, PubMed, and Scopus databases up to 2023. Inclusion criteria comprised cases of complete or incomplete decapitation resulting from hanging, available in full-text and written in English. 16 articles on hanging-induced decapitation met the selection criteria; 22 cases were analyzed. Studies, mostly from Europe, showed a mean victim age of 44.3, all male. Fall height ranged from 1 m to 18 m, with various suspension media. Most cases displayed complete decapitation, primarily between cervical vertebrae C1 and C3. Some cases noted collateral findings. Complete crime scene investigation and thorough post-mortem examination are crucial for reconstructing events, especially with confounding elements. Precise evidence collection and literature comparison are essential to understand the case and substantiate the forensic pathologist's hypothesis in court.

Medial degeneration of the aortic wall represents a critical substrate for the development of acute aortic syndromes, particularly dissection, in both clinically healthy individuals and those with known cardiovascular disease or syndromic features. Among these alterations, Mucoid Extracellular Matrix Accumulation (MEMA) has emerged as a key histopathological marker of aortic fragility, with implications not only for clinical practice but also for forensic investigations of sudden and unexpected deaths. This study presents two autopsy case reports of 41-year-old and 44-year-old individuals who died from acute aortic dissection with no prior evidence of cardiovascular disease or other macroscopic findings that could explain the death. Detailed histopathological examination revealed mucoid extracellular matrix accumulation and associated medial changes; in one case, acute cocaine intoxication was identified as a plausible hemodynamic trigger acting upon an intrinsically vulnerable aortic wall. Furthermore, a narrative review on MEMA and its role in medial layer alteration was conducted, allowing comparison of our findings with existing literature. These cases highlight the forensic significance of identifying medial degenerative lesions in sudden aortic deaths. Comprehensive autopsy and histopathological assessment (hematoxylin-eosin staining) allow the recognition of MEMA and other medial alterations even in individuals without history of cardiovascular disease, support differentiation between intrinsic structural vulnerability and potential external precipitants, and contribute to a more accurate reconstruction of the mechanisms underlying unexpected aortic fatalities. Systematic evaluation of the aortic wall also improves differentiation between intrinsic aortic pathology and external triggers, contributing to scientific understanding and to forensic accuracy, and may support medico-legal evaluations of potential medical malpractice in appropriate contexts.

Background/Objectives: Viper envenomation in Italy is uncommon but carries significant clinical and forensic implications: an average of 257 bites per year are estimated, with only one fatality. This epidemiological context necessitates careful consideration of the standard of care and professional liability The article aims to outline the clinical and medico-legal dimensions of viper bites within both national and international contexts. Methods: We report the case of a 40-year-old woman bitten by a viper in an urban environment. At the initial emergency department visit the presentation was classified as Grade 0 (“dry bite”) according to Boels and, after 21 h, was discharged in good condition. Three days later, she returned with worsening symptoms and CT imaging revealed intrafascial and subcutaneous edema. The subsequent onset of complications prompted a criminal malpractice investigation. Therefore, we performed a PubMed search which yielded 125 records; after applying eligibility criteria, 33 articles were included, supplemented by manual reference checking for a total of 60 sources reviewed. Results: Comparison with the Australian model suggests the need for more standardized care pathways in Italy, while accounting for local toxicological and epidemiological specificities. Conclusions: This case and the accompanying literature analysis highlight that, even in low-incidence settings, structured patient communication, multidisciplinary management, collaboration with Poison Control Centers, and adherence to good clinical practice are crucial for patient safety and for mitigating medico-legal risk.

Background: Fatal sand burial is a rare and diagnostically challenging entity in forensic practice. In such cases, death may result from thoracic or thoracoabdominal compression, airway obstruction by particulate material, massive inhalation of sand or soil, or a combination of these mechanisms. External signs may be subtle or absent, making postmortem interpretation highly dependent on a comprehensive, multilevel assessment. Case Presentation and Methods: We report the case of a 17-year-old male who died following accidental sand burial caused by the collapse of a self-excavated beach tunnel. External examination, autopsy, histological and toxicological analyses were performed. A review of the literature was also conducted to identify published forensic cases of fatal sand or soil burial and to compare circumstantial, macroscopic, microscopic, and ancillary findings. Results: Autopsy revealed marked pulmonary edema and congestion, multivisceral congestion, scattered sand granules within the larynx, and epicardial petechiae. Histological examination demonstrated acute pulmonary emphysema, edema, vascular congestion, and hemorrhagic laterocervical lymph nodes. Overall, the findings were considered most consistent with mechanical asphyxia due to thoracic compression. The literature review identified six eligible studies describing eight fatal cases. Despite the limited sample size and marked heterogeneity, two main diagnostic patterns emerged: compression-related deaths, usually associated with tunnel or beach-hole collapse and minimal or absent particulate material within the airways, and aspiration-/obstruction-related deaths, characterized by abundant or compact sand or soil material within the airways. In cases without massive aspiration, mixed mechanisms may coexist. Pulmonary edema and congestion were the most frequently reported autopsy findings. When available, histological examination appeared useful in distinguishing antemortem from postmortem burial. Conclusions: Fatal sand burial should not be regarded as a uniform forensic entity. External examination alone is often insufficient, and accurate diagnosis requires a comprehensive, multidisciplinary approach integrating scene reconstruction, autopsy data, histopathological findings, and ancillary analyses. Hemorrhagic involvement of the laterocervical lymph nodes may represent a potentially relevant but currently underexplored finding, whose diagnostic significance warrants further investigation in analogous cases.

Cutaneous electrical marks may provide the principal localized morphological evidence of contact with an electrical conductor, but their histopathological interpretation remains challenging. We investigated the topographical relationship between dermo-epidermal detachment and junction-associated Laminin-Receptor/Ribosomal Protein SA (Laminin-R/RPSA) immunoreactivity in 25 full-thickness skin specimens from documented fatal electrocution cases. Detachment on hematoxylin and eosin (H&E) staining was initially classified as present, absent, or equivocal, with discordant or equivocal assessments subsequently adjudicated by a supervising observer. After adjudication, detachment was present in 22 specimens (88%) and absent in three (12%). All 22 specimens with detachment lacked detectable junction-associated Laminin-R/RPSA immunoreactivity at the corresponding interface, whereas all three specimens without detachment retained the signal. All 25 preserved perilesional regions showed retained immunoreactivity. The paired absolute difference in the proportion showing loss of immunoreactivity between lesion and perilesional sites was 88.0 percentage points (95% CI, 55.5–97.5; exact McNemar p < 0.0001). These findings demonstrate a consistent spatial correspondence between dermo-epidermal separation and localized loss of detectable Laminin-R/RPSA immunoreactivity. Because the antibody targets RPSA rather than laminin-332, the results do not directly establish laminin-332 damage. Laminin-R/RPSA immunohistochemistry may complement conventional H&E examination, but controlled comparative studies are required to determine specificity and reproducibility.