Case ReportsPostmortem Otorrhagia in Positional AsphyxiaBugelli, Valentina MD, PhD∗,†; Campobasso, Carlo Pietro MD, PhD‡; Angelino, Amalia MD†; Gualco, Barbara PsyD†; Pinchi, Vilma DMD, PhD†; Focardi, Martina MD†Author Information From the ∗Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio,” Università degli Studi del Molise, Campobasso †Dipartimento di Scienze della Salute, Sezione di Scienze Medico Forensi, Università di Firenze, Firenze ‡Dipartimento di Medicina Sperimentale, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy. Manuscript received January 5, 2020; accepted March 28, 2020. Classifications: 10: Forensics/10.010: Pathology/10.020: Medicine/10.190: Autopsy. The authors report no conflicts of interest. Reprints: Amalia Angelino, MD, Dipartimento di Scienze della Salute, Sezione di Scienze Medico Forensi, Università di Firenze, Largo Brambilla, 3, 50134, Firenze, Italy. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: September 2020 - Volume 41 - Issue 3 - p 217-219 doi: 10.1097/PAF.0000000000000559 Buy Metrics Abstract Otorrhagia is generally associated with basilar skull fractures or diving accidents. In routine forensic medical practice, an accurate knowledge of the etiology of otorrhagia may have a key role to distinguish between traumatic and atraumatic causes and accidental, homicidal, or suicidal manners. The authors present the case of an unusual cause of atraumatic otorrhagia occurred in an elderly farmer found dead in a barn. He remained entrapped in a narrow tunnel created by some hay bales. The autopsy findings revealed only an intense polyvisceral congestion and subpleural petechiae, with no signs of traumatic injuries and no fractures of skull base or temporal pyramid. The cause of death was determined to be positional asphyxia, and the manner of death was deemed accidental. In fact, the head-down position resulted in diaphragm compression causing respiratory failure in combination with the stasis of the upper venous circle districts. Mechanical and gravitational forces related to upside-down position and increased vascular pressure also caused postmortem otorrhagia. In this case, the death scene investigation and circumstantial information allowed for reconstruction of the unique dynamics of the death. At the death scene, the position of the corpse must be accurately investigated because it can explain some cadaveric findings such as the ear bleeding or other markers of increased cephalic venous pressure like pink teeth, facial and conjunctival petechiae, or Tardieu spots. Therefore, forensic pathologists should consider that ear bleeding in dead bodies is not always the evidence of severe head blunt trauma or diving accidents, but it might be a postmortem phenomenon mostly related to body position. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.