CONTUSIONS
(Bruises)
Definition
Contusions is an infusion are
effusion of blood into tissue
due to rupture of blood vess
els caused by blunt objects.
Blunt objects such as stick ,st
one,fist,hammer,axe,poker,bo
ot,etc.
Types:
1)Intradermal
2)Subcutaneous
3)Deep
Situation
• Present on skin
• Also present on internal organs such as
lungs,heart,brain ,muscels and any tiss
ue
• Usually situated in cornium and subcu
taneous tissues,above deep fascia,ofte
n in fat layer.
Features
• Painful swelling
• Crushing and tearing of subcutaneous tissue
• Extravasated blood diffusely distributed in tis
sues spaces
• Margins are blurred
• May be seen with abrasion or laceration
• Finely mottled and stippled ( petechial bruise
s)
• If larged vessel injured heamatoma is formed
.
Bruises also called Ecchymoses
• Petechia become larger and confluent
• Freshed bruise usually tender, slightly rised above t
h skin
• Deep seated bruise shows swelling
• Bruise has lighter colour in the center because extra
vasated blood is pushed outward by impact.
• Mongolian spot (hyperpigmented skin in lumbosac
ral region) should not be confused with contusion
size
• Varies in size from pinhead to large colle
ction of blood in the tissues.
• It is slightly larger than the surface of the
agent which caused it,as blood continues
to escape into the area.
• Development of marked tissue swelling i
n the vicinity of a bruise usually results i
n loss of its original shape.
Factors modifying size &shapes
:
1) Condition & type of tissue :
- If part is vascular and loose, a slight degree o
f violence may cause a large bruise, as there is
sufficient space for blood to accumulate.
- Bruising of the scalp is better felt than seen.
-Bruising of the scalp with fluctuant centres ca
n simulate depressed fracture.
Age & sex
• children bruise more easily because of so
fter tissues & delicate skin,and old perso
ns bruise easily because of loss of flesh &
cardiovascular changes.
• Women bruise more easily than man , be
cause the tissues are more delicate and s
ubcutaneous fat is more.
colour of skin
• Bruising is more clearly seen fair - skinned persons t
han those with dark skin,in whom they may be bett
er felt than seen.
• The areas of extravasated blood appear darker even
on heavily pigmented negroid skin.
• Skin bruises become more prominent probably:
• 1) by forcing additional blood into damaged area
• 2) increased transparency of overlying skin
• 3) formation of a dark pigment complex
Natural disease
• When the vessels are diseased as in arterioscler
osis, bruising occurs very easily
• In children, small bruises may be caused by voil
ent coughing
• prominent bruising seen in purpura haemorrha
gica, leukaemia,haemophilia, scurvy, vitamin K
and prothrombin deficiency and in phosphorus
poisoning.
• Many old persons develop senile ecchymoses a
ll over their bodies, esp. on extremities.
Gravity shifting of blood
• Blood will track along the fascial planes which fmm th
e least resistance and may appear where the tissue la
yers become superficial.
• Haemorrhages in the soft tissues around the eyes an
d in the eyelids may be caused by
• 1) direct trauma, such as a punch in the eye,
• (2) blunt impact to the forehead, the blood gravitatin
g downwards over the supraorbital bridge,
• (3) fracture of the floor of the anterior fossa of the sk
ull.
Battle's sign
• fracture of the _ Bruise appear in ne
jaw ck
• fracture of the _ Bruise appear in thi
pelvis. gh
Lower part of thigh
• fracture of the _ Bruise around ankle
femur
• kick on the calf _ o
f the leg
Patterned Bruising
• one in which the size and shape, m
irror a portion of object which caus
ed it.
• With heavier impacts or are crushe
d, and the contusion pattern is soli
d rather than outlined.
Patterned Bruising
Blow with solid body Produces rounded
hammer or closed fist bruise
Thick stick elongated&irregulr
Blow with rod ,whip Linear heamorrhage
board flat weapon Cause parallel
(plank) bruise on skin
Patterned Bruising
Blows from whips Elongated,curved &
encircled on body
Strap ,belts & chains Definite imprint
contact injury from bruise with outline of
firearm muzzle of weapon
Sucction or biting on Elliptical pattern
side of neck & breast bruised
Patterned Bruising
Objects with Diatorted
alternating ridges skin,intradermal
& bleeding & red lines
grooves(tyers,sole produce on skin
of shoes)
Clothing grabbed Petchial
& twisted over haemorrhages &
skin texture of cloth on
skin
Delayed bruising
• A deep brusie may takes several hours or 1-2
days to appear and deeper extravasation of b
lood may never appear.
• An injury is produced before death, the bruis
e may appear some time after death, due to
further escape of blood from the ruptured ve
ssels due to gravitation mainly due to percola
tion, and rapid haemolysis of stagnant blood,
the pigment diffusing locally and producing a
stain on the surface (come-out bruise).
Deep Tissue and Organ Contusions
• Deep contusions are clearly seen during autopsy, a
s the blood is drained from blood vessels and also
due to postmortem autolytic changes.
• Contusion of brain initiate swelling with gradual a
ccumulation of acid by-products of metabolism wit
h impairment of function.
• A small contusion of the heart can cause serious di
sturbance of normal stoppage of cardiac action an
d death.
• Contusion to other organs can cause rupture & inte
rnal bleeding.
Age of bruise
• A bruise heals by destruction and removal of
the extravasated blood.
• Factors affecting colour of contusion include:
1. Depth of bleeding,
2. amount of bleeding,
3. enviornmental lighting,
4. overlying skin colour
Age of bruise
• The colour change starts at the periphery and ext
ends inwards to the centre.
• At first: Red.
• Few hours to 3 days : Blue.
• 4th day : Bluish-black to brown(haemosiderin)
• 5 to 6 days : Greenish (haematoidin).
• 7 to 12 days : Yellow (bilirubin).
• 2 weeks: Normal
Antemortem and Postmortem
Bruising :
• Produce immediatly after death
• Show marked decrease in acidic mucopolysaccharides of th
e connective tissue ground substance, as demonstrated by
Alcian Blue or dialysed iron technique.
• On microscopic examination,the presence of tissue reactio
n of a degree beyond a margination and limited emigration
of the white cells indicates that the contusion was antemor
tem.
• The margins of postmortem bruises are usually quite sharpl
y defined, and those of antemortem bruises are less sharp
or indistinct for the greater part, indicating vital reaction in
the damaged tissues.
Decomposed bodies
• In scalp, heamolysis of RBC prod
uce diffuse discolouration of soft
tissue due to which it becomes i
mpossible to differentiate betwe
en antemortem contusion and an
area of postmortem hypostasis.
Medicolegal Importance
• Pattern bruises may connect the victim and the object o
r weapon.
• The age of the injury can be determined by colour chan
ges.
• The degree of violence may be determined from their si
ze.
• Character and manner of injury may be known from it's
distribution.
• Indicating the position of assailant in front of, or behind
the victim.
• Brusing of the arm may be a sign of restraining a person
.
Medicolegal Importance
• Bruising of the shoulder blades indicate firm
pressure on the body against the ground or
other resisting on surface.
• Bruising of thigh especially inner aspect, an
d of genitalia indicates rape.
• In open wound wounds, dirt, dust, grease or
particles of stone or sand are usually presen
t, which may connect the injuries to the sce
ne of crime.
Complications
• A contusion may contain 20 to 30 ml. of blood or
even more. Multiple contusions can cause death f
rom shock and internal haemorrhage.
• Gangrene and death of tissue can result.
• The pooled blood can serve as a good site for ba
cterial growth, especially by clostridial group.
• Rarely, in severe sudden compression of the subc
utaneous tissue, pulmonary fat embolism may oc
cur.
