Entrapment within an ottoman storage bed: an unusual accidental asphyxial death

The victim was a 56-year-old woman whose body was found by the rescue team to be in the prone position and trapped inside an ottoman storage bed, which consisted of a mechanism that lifted the bed base and mattress to reveal a storage space beneath them. Upon our arrival, the body had already been removed from its original location for rescue purposes and was lying supine on the floor near the bed, with the head rotated towards the left side, the arms abducted, the forearms flexed, and the lower limbs abducted and flexed at the knees (Fig. 1A). Examination of the body revealed fixed purple hypostases dotted with petechiae located on the face, chest and upper abdominal quadrants, with a pale rectangular-shaped area extending from one arm to the other, including the anterior surface of the neck and bilateral clavicular regions. Fixed hypostasis was also distributed on the anterior surface of the upper limbs and the palms. Another area spared from hypostasis was recognizable at both wrists. Rigor mortis involved the jaw and both upper and lower limbs. The body temperature was equal to the environmental temperature. Inspection of the bed revealed traces of blood smearing the lateral edge of the container below the bed (Fig. 1B, C, black arrow). The mattress was cluttered with clothes and blankets (Fig. 1B, C). The bed suspension mechanism was defective, as it was not equipped with the system designed to hold up the mattress. At room inspection, several packages of antidepressants and benzodiazepines were found.

A forensic autopsy was performed 3 days after death was pronounced. The deceased individual was 150 cm in height and 55 kg in weight. At autopsy, the distribution of postmortem lividities was comparable to that found at the death scene investigation (DSI) (Fig. 2A). The conjunctivae were completely engorged with blood, the face was swollen and congested, and the tongue protruded between the dental arches. Mouth and nose bleeding and cyanosis of the face and both hands were observed. An oval-shaped abrasion, with a size of 4.5 × 2.5 cm, was noticed under the chin on the right side (Fig. 2B). On the posterior cervical region, an oval-shaped abrasion with a length of 5 cm and a width of 3 cm was detected (Fig. 2C). Upon internal examination, although diffuse haemorrhagic infiltration of the scalp over the frontal and bilateral temporoparietal regions was noticed, neither fractures of the cranial bones nor encephalic lesions were identified. Upon anterior and posterior dissection of the neck, the soft tissues corresponding to the above-described abrasions were infiltrated with blood, while the cervical vertebrae were not fractured. Both jugular veins were dilated (Fig. 2D). The lungs were markedly congested and overinflated. Hyoid bone and larynx specimens were collected to perform a micro-computed tomography (micro-CT) analysis, which is useful to detect any potential fractures or microfractures.

Histological examination of the lungs displayed acute pulmonary emphysema with a predominantly subpleural disposition; in other areas of the pulmonary parenchyma, atelectasis, intra-alveolar oedema and vascular congestion were observed. Other histological findings were chronic bronchitis and macrophages within the alveolar spaces. Toxicological analyses in blood revealed subtherapeutic concentrations of diazepam, flurazepam and escitalopram, while no ethanol or drugs of abuse were detected.

The larynx and hyoid bone were scanned using a micro-CT 1275 device (Skyscan, Bruker, Kontich, Belgium; 15.7 µm isotropic voxel size, 83 kV, 120 µA, exposition time 6050 ms, rotation step 0.7, frame averaging 2, 1280 × 1024 pixel field of view). CTVox (Skyscan, Belgium) was used to elaborate the 3D volumetric reconstructions. The micro-CT scan showed no dislocations or fractures of the larynx or the hyoid bone (Fig. 2E).