Internal Examination

Serosal surfaces, blood, and organs appear "cherry-pink" (Fig. 67; refs. 490 and 540). This is useful if cutaneous lividity cannot be assessed (540). Formalin fixative turns bright red when exposed to tissues in cases of CO asphyxia (Fig. 67) (490,540).

Fig. 67. Carbon monoxide poisoning. (A) Bright red discoloration of pleural lining in a dark-skinned individual (courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC. (B) Formalin-fixed stock autopsy tissue. Bright red fixative owing to carbon monoxide in jar on left side. (See Companion CD for color version of this figure).

Pathological changes from CO poisoning are seen in hospitalized patients and long-term survivors. Lesions in the heart vary from petechial hemorrhages to myocardial necrosis (496). Rhabdomyolysis from the direct toxic effects of CO and prolonged immobility lead to renal failure (see Chapter 8, Heading 13. and refs. 465, 479, and 543-545). Neuronal hypoxic injury is most pronounced in the deep gray matter, usually in a symmetrical distribution, and although not pathognomonic, may be the only indication of previous CO-related brain injury (465,479,490,546,547). Widespread hypoxic neuronal degeneration and cerebral white matter degeneration also occur (546-548). Delayed neurological and psychiatric symptoms can develop following a period of initial improvement (462,463,475,483,500,546,548,549).

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