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Autopsy-Proven Determinants of Immediate Fire Death in Lungs

de Paiva, Luiz A. S. MD, PhD*‡; Parra, Edwin R. MD, PhD; da Rosa, Danieli C. MD; Farhat, Cecília MS; Delmonte, Carlos MD, PhD*; Capelozzi, Vera L. MD, PhD

The American Journal of Forensic Medicine and Pathology: December 2008 - Volume 29 - Issue 4 - p 323-329
doi: 10.1097/PAF.0b013e31818736cd
Original Article

In immediate fire deaths, pulmonary injury may be the main source of mortality, being important to document the histologic findings for the purpose of excluding other modes of death, such as from asphyxia with no gross findings. In this context, a group of morphologic determinants have been targeted with useful makers of pulmonary injury. To facilitate the determination of whether an individual was deceased before the start of a fire and validate the importance of parenchymal alterations in pulmonary injury in fire deaths, we studied lungs in victims of fire (N = 28) and suffocation (N = 40), creating a mathematical model using cluster analysis. For this purpose, a semiquantitative analysis of the distal parenchyma was performed to evaluate the amount of bronchiolar dilatation, overinsufflation (ductal and alveolar), collapse (ductal and alveolar), passive congestion, alveolar edema, and hemorrhage (interstitial and alveolar). These 7 histologic determinants were useful to discriminate fire (bronchiolar dilatation, ductal overinsuflation, alveolar overinsuflation, alveolar hemorrhage) from suffocation lung injuries (alveolar collapse, congestion, and edema). We conclude that these determinants should be included in the routine of forensic pathology.

From the *Institute of Forensic Medicine, São Paulo, Brazil; †Department of Pathology of Faculdade de Medicina da Universidade de Säo Paulo, Brazil, and Laboratories for Medical Research, Hospital das Clinicas da Faculdade de Medicina da Universidade de Säo Paulo, Brazil; and ‡Department of Pathology of the University of São Paulo, São Paulo, Brazil.

Manuscript received September 29, 2006; accepted April 6, 2007.

Supported by National Council for Scientific and Technological Development, CNPq 300430/95-7; Foundation for the Support of Research of the State of São Paulo, FAPESP 2000/14336-0; Laboratories for Medical Research, LIM 05; and Clinicas Hospital, School of Medicine, University of São Paulo.

Deceased, Carlos Delmonte, MD, PhD.

Reprints: Vera Luiza Capelozzi, MD, PhD, Departamento de Patologia–Faculdade de Medicina da USP, Av. Dr. Arnaldo, 455–CEP: 01246-903, São Paulo, Brasil. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.