Are Wischnewski Spots Found Only in Hypothermia?

Min Kyu Noh; SangHan Lee

doi:10.7580/kjlm.2019.43.1.16

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Noh and Lee: Are Wischnewski Spots Found Only in Hypothermia?

Original Article

Korean Journal of Legal Medicine 2019; 43(1): 16-22.

Published online: 28 February 2019

DOI: https://doi.org/10.7580/kjlm.2019.43.1.16

Are Wischnewski Spots Found Only in Hypothermia?

Min Kyu Noh¹, SangHan Lee²

¹Graduate School of Forensic and Investigative Science, Kyungpook National University, Daegu, Korea.

²Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

Correspondence to SangHan Lee. Department of Forensic Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-4887, Fax: +82-53-422-4712, sanghan1@knu.ac.kr

Received 30 January 2019 Revised 16 February 2019 Accepted 22 February 2019

The Korean Society for Legal Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Wischnewski spots (WS) are multiple black spots observed in the gastric mucosa at autopsy that are considered a reliable and important feature of hypothermia. Nonetheless, the frequency of WS varies widely. WS were discovered in 20 cases out of 3,493 autopsies (0.57%) conducted between 2001 and 2017 in the Department of Forensic Medicine of the School of Medicine, Kyungpook National University in Korea. This study aimed to investigate the distribution and size of WS in these cases and analyze the respective causes of death. Nine cases that occurred in winter were the same as the nine cases with hypothermia as the cause of death or contributory cause. The post-mortem blood alcohol test was positive in eight cases, with acute or chronic alcoholism determined as the cause of death in two of these cases. There were two cases of acute poisoning by pesticides. Putrefaction was noted in six cases (30%). WS presented in various sizes ranging from pinpoint to more than 5 mm in diameter, and the number of WS varied from 5 to 100. WS distribution was diffuse in four cases (20%) and localized in 13 cases (65%). Microscopic examination showed brown to black pigmentation but no neutrophil infiltration or vital reactions in the WS. Thus, WS are associated with hypothermia and are considered post-mortem alterations with variable appearance, size, and distribution. Hypothermia is an exclusive diagnosis at autopsy that should result from a combined assessment of toxicological tests, circumstance of death, and autopsy findings.

Keywords: Wischnewski spots, Hypothermia, Autopsy

Figures and Tables

Fig. 1

Wischnewski spots (WS) of gastric mucosa. (A, B) Gross appearance of the stomach of case No. 6 (large sized WS). (C, D) Gross appearance of the stomach of case No. 2 (medium sized WS). (E, F) Gross appearance of the stomach of case No. 1 (pinpoint to small sized WS).

Fig. 2

H&E stain of gastric mucosa of case No. 2. The brown to black pigmentation is shown, but there is no neutrophil infiltration (A, ×40; B, ×200).

Table 1

Reviews of cases in which Wischnewski spots were found during the autopsy

COPD, chronic obstructive pulmonary disease; CoAs, coronary atherosclerosis; ICH, intracerebral hemorrhage; DM, diabetes mellitus; TA, traffic accident; NA, not available.

Table 2

Characteristics of Wischnewski spots according to the size, count, distribution, and classification of size in 17 autopsy cases

Case 12, 13, and 18 are excluded. Large character in the field of classification of size means major size of Wischnewski spots.

Notes

^{Conflicts of Interest} No potential conflict of interest relevant to this article was reported.

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ORCID iDs: SangHan Lee
https://orcid.org/0000-0003-0390-3494
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