22203              ACCIDENTAL STRANGULATION

This patient was a man aged 41 who worked as a telephone linesman.  A weighted wire broke and wrapped around his neck while he was at work in the country.  He was conscious briefly at a country hospital after being cyanosed and comatose for 40 minutes.  On transfer to the R.A.H. he was comatose and cyanosed.  Ventilation was restricted by profuse bleeding into the tissues of the neck.  The neck was explored and a tracheostomy was inserted.  The right internal carotid artery was found to be thrombosed and was tied off.  He died next day.  At postmortem two intimal tears were found in the left internal carotid artery with some recent thrombus adherent to the upper tear, though the lumen was not obliterated.

The specimen is the tongue, larynx and upper respiratory passages together with the left carotid artery.  There is very massive injury with complete avulsion of the epiglottis through the base of the tongue.  Surrounding tissues are swollen and heavily infiltrated with acute haemorrhage which has tracked down over the surface of the thyroid gland.  The vocal folds are swollen but are not torn and the aryepiglottic folds are intact though infiltrated by haemorrhage anteriorly.  The tracheostomy opening is visible at the bottom of the specimen.  Two tears can be seen in the intima of the carotid artery.  The upper tear slows avulsion of the intima over a length of about 1 cm with a layer of acute thrombus adherent to the surface.