The case we are dealing with is that of a young woman with a history of mental disorders, who has been precipitated from a height.
External examination revealed a figured ecchymosis of the street (located in forearms, abdomen and thighs).
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Other external injuries observed were: bilateral lower limb fracture-dislocation at the knee level, hematoma on the left lower limb face, incomplete lower limb fracture, and incomplete dorsal flat urticaria.
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The opening of the thoracic cavity reveals the existence of vital bilateral rib fractures with the presence of hemorrhage in the intercostal muscles of the area, accompanied by significant bilateral hemothorax.
Pulmonary eversion allows the observation of bilateral hemorrhages in the pulmonary hilium.
After opening the pericardium, an important hemopericardium was observed, which concealed the cardiac mass.
A more careful examination of the heart allows observing the existence of a tear by traction of the right pulmonary vein at the intrapericardial level, origin of the hemorrhage.
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In the abdomen there was an important hemoperitoneum caused by liver and splenic rupture.
The kidneys had intraparenchymal bleeding.
A temporary contusion affecting the periosteum is observed in the cephalic extremity autopsy and no fractures of the vault or cranial base are observed after removal of the meninges.
After the combined extraction of brain and cerebellum there is evidence of tearing of the corpus callosum in the area of its anterior commissure and the area called knee of the corpus callosum.
COMMENTS:
The etiology of the precipitate can be suicidal, accidental and dangerous; even, it can be a way to get rid of a corpse, simulate a precipitation.
Precipitation is the mechanism most used by suicides in our environment.
Its incidence varies according to several studies, with frequencies published between 42% [1] and 34% [2].
Falls from a high site cause large internal injuries, while external injuries are not very apparent (Tourdes' sign) [3]; however, in this case, the abdomen and extremities around the floor are observed in the abdomen.
The most common visceral lesions are hepatic and usually consist of cracking, linear fissures and tears located especially on the upper face [4].
The tears can occur at the depths of the organ without damage and there are hemorrhages that increase until rupture of the organ, causing late peritoneal bleeding [5].
The spleen is more protected and therefore less damaged than the liver [6].
It is important to visualize them "in situ" before any manipulation to avoid artifacts.
Lesions can range from superficial tears of the capsule to massive rupture, resulting in the production of a hematoma with late rupture.
Heart injuries are less frequent than liver injuries.
Valve ruptures can occur in patients with myocardial infarction (the most common), atrial or ventricular ruptures [7].
Vascular ruptures are much rarer, as in our case.
Under normal conditions, the peripherical cavity contains approximately 15-30 ml of fluid and peripherical pressure oscillates between 0 and -3 mm Hg.
[8].
This pressure increases with the output of blood to the pericardium and may lead to cardiac tamponade.
The amount of liquid that can cause a lidding in acute cases is about 200 ml.
In chronic effusions it can accumulate up to 2000 ml [9].
