Discoloration

Livid skin is either purple/blue or red, depending on the concentration of deoxy-genated blood. Red livor is seen if the body is cold (Fig. 10). This is indistinguishable from certain poisoning deaths (e.g., carbon monoxide poisoning [33]). Lividity is difficult to discern in a dark-skinned individual. Decomposition turns livid areas brown or green. Dependent organs and tissues appear "congested" or hemorrhagic (e.g., if supine, posterior lungs and retroperitoneum, including kidneys; if prone, anterior organs such as heart and intestines).

• Significance

° Lividity is poorly developed in individuals who are anemic, have bled severely, or had organs harvested.

Fig. 11. Person found dead with thigh resting on rotary telephone. "Negative" impression of dial and extension cord in livid area.

° Apparent cyanosis of the face could be lividity. The heart of a large individual is at a higher level than the more dependent head.

° Different colors of lividity are associated with certain poisoning deaths (1):

Red—carbon monoxide (see Chapter 3, Subheading 3.9.; see also Fig. 12); fluoroacetate; cyanide.

Green—hydrogen sulfide (also generated during decomposition). Brown—methemoglobinemia (e.g., ingestion of nitrates; see also Fig. 13). Intense purple—propane (34).

° During the initial external examination, livor can obscure an antemortem contusion (Fig. 14). Body repositioning during the autopsy can shift lividity from an apparent bruise, allowing better visualization. The suspicious area can be examined at the conclusion of the autopsy dissection, when blood has drained from the body and the intensity of lividity has diminished. Re-examination of a refrigerated autopsied body the next day may reveal bright red but diminished livor in contrast to a darker bruise (Fig. 14).

° Antemortem injuries are mimicked by lividity. Patchy red/blue skin discoloration suggests a contusion. If such an area is due to nonfixed lividity, then thumb blanching helps distinguish it from a bruise. Similarily, incision of an area of lividity is more likely to result in oozing of nonclotted blood from vessels in contrast to a true contusion, where blood has seeped into soft tissue.

Fig. 12. Red livor mortis on back. Carbon monoxide poisoning. (See Companion CD for color version of this figure.)
Cyanosis Carbonmonoxide Poisoning
Fig. 13. Brown livor mortis on back. Methemoglobinemia owing to nitrate ingestion. (See Companion CD for color version of this figure.)

Fig. 14. Woman strangled using armhold. (A) Pale linear lines on lateral aspect of neck are caused by neck creases in area of livor mortis. Indistinct bruises (arrowheads) (B) Examination of the deceased next day after autopsy dissection. Lividity diminished allowing visualization of extensive bruising (arrowheads) on lateral neck. (See Companion CD for color version of this figure.)

Fig. 14. Woman strangled using armhold. (A) Pale linear lines on lateral aspect of neck are caused by neck creases in area of livor mortis. Indistinct bruises (arrowheads) (B) Examination of the deceased next day after autopsy dissection. Lividity diminished allowing visualization of extensive bruising (arrowheads) on lateral neck. (See Companion CD for color version of this figure.)

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