Copious white leathery tenacious froth in a case of hanging – An arcane presentation

Abstract

Abstract The presence of froth during autopsy in cases of asphyxial death has been widely studied and attributed to drowning. Although hanging is the most common cause of mechanical asphyxia in comparison to drowning, frothing observed in cases of hanging has not been reported. Herein, we describe a case of an 18-year-old married pregnant woman who attempted suicide by hanging. During the postmortem examination, the presence of copious, white, tenacious, leathery froth forming a mushroom-like mass was observed. Furthermore, internal examination and histopathological evaluation revealed noncardiogenic pulmonary edema to be the likely cause of death. Although the development of postobstructive pulmonary edema has been effectively studied in sublethal cases of hanging, with appropriate ventilation management, mortality associated with such cases has drastically reduced. Thus, the incidence of frothing noted in such cases of hanging has not been described. Pulmonary edema, which subsequently develops in patients with hanging, is an unfamiliar and unusual cause of death. Hence, we conclude that autopsy surgeons must watch out for other causes of frothing and must investigate for evidence of its differentials, not limited to only cases of drowning. This finding also becomes important for emergency physicians to consider the development of interstitial edema in the setting of nonlethal hanging.