HENNEPIN COUNTY



PRELIMINARY AUTOPSY REPORT

DECEASED: Beatrice Fulcosa

SEX: Female AGE: 36

PATH MD: GALENA FELDSPAR

36-year-old FEMALE found dead in her office by co-worker on October 27, 2016 at 7:05 am.

The body was first seen by me after I was called to Marvin G. Brown School in Queens New York. I arrived approximately 7:30 a.m. and entered the office where the decedent's body was located. I viewed the body on the floor of the room. The decedent was lying on her back with her arms extended to the sides, in the space between her desk and the window.

The head was turned to the right. A quick examination of the body revealed several scars on her left check and right arm. In addition there was extensive damage to the top and back of the head. Pieces of scalp and skull were sprayed around the area were the body lay.

There was also much blood splatter around the room.

EXTERNAL EXAMINATION

The body is that of a well-developed, well-nourished white female, 5’6” tall, 120 pounds, whose appearance is consistent with the reported age of 36 years, 2 months.

Lividity is present and fixed (non-blanching) on the back of the neck, upper back, lower back, and back of the thighs. Livor mortis is also present on the right side of the face.

At the time of my arrival at the crime scene, there is moderate (2+ to 3) rigor mortis of the joints of the lower extremities, with more advanced (3 to 4+) rigor mortis of the elbows and shoulders.

Rectal temperature at the crime scene at 7:30 am was 81 degrees Fahrenheit, while the room temperature was recorded as 78 degrees Fahrenheit.

The scalp is covered with long, dark brown hair in a normal distribution. The irides are hazel, and the pupils are round and equal in diameter. The sclera is red-lined with the left eye containing a significant amount of blood. There are no bulbar or palpebral conjunctival petechiae. The lobe of each ear has been pierced. The ears are otherwise unremarkable. The nares are patent and the lips are atraumatic. On the left cheek is a pattern of dried saliva and mucous material which does not appear to be hemorrhagic. The nose and maxillae are palpably stable. The teeth appear native and in good repair. The tongue is smooth, pink-tan and granular.

The neck contains no palpable adenopathy or masses and the trachea and larynx are midline. The chest is symmetrical. Breasts are firm and appear to be implants. The abdomen is flat and contains no scars. No palpable organ omegaly or masses are identified.

The external genitalia are unremarkable. Pubic hair are present in a normal distribution. There is no evidence of forcible sexual contact. There is, however, evidence for recent sexual activity and vaginal fluids were removed for analysis. Examination of the back, buttocks and anus is unremarkable.

Examination of the extremities is unremarkable. On the ring finger of the right hand is a yellow metal band with a large (approximately 3 karat) diamond. Around the right wrist is a yellow metal bracelet. The fingernails of both hands are painted red and are of sufficient length for clipping.

EXTERNAL EVIDENCE OF INJURY

Located just below the left ear at a right angle of the mandible, below the right external auditory canal is a 1 inch x 1 inch area of rust colored abrasion. The remaining left side of the face has a large rounded break and bruising. The top of the skull has a star shaped break with some pieces of skull and scalp missing. This same pattern is present on the back right side of the skull. Livor mortis on this side of the face makes identification difficult.

Located on the left side of the chin is a three-sixteenths by one-eighth of an inch area of superficial abrasion. On the posterior aspect of the left shoulder is a poorly demarcated, very superficial focus of abrasion/contusion which is pale purple in color and measures up to three-quarters by one-half inch in maximum dimension.

Several linear aggregates are present on the right forearm between the wrist and elbow. These measure up to one inch in length by one-sixteenth to one-eighth of an inch in width. On the right lateral aspect of the lower back, approximately sixteen and one-quarter inches and seventeen and one-half inches below the level of the top of the head are two dried purple abrasions. The more superior of the two measures one-eighth by one-sixteenth of an inch and the more inferior measures three-sixteenths by one-eighth of an inch.

There is smeared blood on the palm side of the right hand but no abrasions.

INTERNAL EXAMINATION

No sternal or rib fractures are identified

All internal organs appear normal and consistent with a 36 year old female.

The esophagus is empty and lined by a grey-white mucus.

Approximately 125 ml of partially digested semisolid food is found in the stomach. The food includes salmon, asparagus and potatoes. The proximal portion of the small intestine contains fragmented pieces of yellow vegetable or fruit material, which may represent fragments of pineapple. The remainder of the small intestine is unremarkable. The large intestine contains soft green fecal material.

Located just below the left ear at a right angle to the mandible there is a 1 inch x 1 inch area of rust colored abrasion. Examination shows a few radial fractures. The remaining left side of the face has a large rounded break and bruising with multiple radial fractures into the skull. The top of the skull has a star shaped break with some pieces of skull and scalp missing. Upon close examination the pieces collected at the scene match and complete the skull. This same pattern is present on the right side of the skull.

Located on the left side of the chin is a three-sixteenths by one-eighth of an inch area of superficial abrasion. This area exhibits the same pattern of radial fractures to the bones.

On removal of the skull cap there is found to be a thin film of subdural hemorrhage measuring approximately 8-10 cc over the surface of the left cerebral hemisphere and extending around to the back of the cerebral hemisphere. Inflammation is present consistent with head trauma. There is a thick film of subarachnoid hemorrhage overlying the entire left cerebral hemisphere. On the left cerebral hemisphere underlying the previously mentioned linear skull fracture is an extensive linear area of purple contusion 20 inches in length by 3.75 inches in width.

Brain sections from the areas of contusions disclose disrupted blood vessels of the cortex with surrounding hemorrhage.

EVIDENCE

Items turned over to CSI as evidence include: Fibers and hair from clothing and body surfaces; clothing; vaginal swabs and smears; rectal swabs and smears; oral swabs and smears; paper bags from hands; fingernail clippings; jewelry; paper bags from feet; white body bag; samples of head hair eyebrows, eyelashes and pubic hair; swabs from left thighs and right cheek; fingerprints.

A. Based on the autopsy report write a Final Diagnosis of this case. Your diagnosis should answer the following questions:

( 36.9 ∘ C − rectal temperature in Celsius ) ⋅ 6 5 {\displaystyle (36.9^{\circ }C-{\text{rectal temperature in Celsius}})\cdot {\frac {6}{5}}} [pic]

1. Is the location of the body consistent with the location of livor mortis? Explain

2. Determine an approximate time of death using livor mortis alone

3. Determine the approximate time of death using rigor mortis alone

4. Use algor mortis to calculate the approximate time of death. Show your work

5. Is the calculation of PMI using algor mortis consistent with livor and rigor mortis? Explain.

6. Using stomach contents, how much time lapsed between the victim’s last meal and death? Explain.

7. Determine cause, mechanism and manner of death.

Cause:_______________________

Manner:______________________

Mechanism:___________________

B. All five suspects were recorded by the building cameras exiting Marvin G. Brown HS some time between 8:45pm and 9:06pm. Based on the camera records and your PMI determination, is it possible to exclude any of the suspects? Explain.

[pic]

Stages of Rigor Mortis

There are six stages of rigor mortis in humans. These different stages can be used to assist in determining the exact time of death when needed.

1. Absent

In this stage, the body is still receiving small bits of oxygen anaerobically. The muscles are still soft.

2. Minimal

The body’s muscles have just begun to stiffen up. The face muscles are typically the first to experience the change.

3. Moderate

More muscles are beginning to stiffen and it has become obvious that the body is no longer loose or flexible.

4. Advanced

The majority of the muscles in the body are stiff and rigid.

5. Complete

All of the muscles in the body are hard and rigid.

6. Passed

Rigor mortis has ended and the body can now move into the next stage of death.

A measured rectal temperature can give some indication of the time of death. Although the heat conduction which leads to body cooling follows an exponential decay curve, it can be approximated as a linear process: 2° Celsius during the first hour and 1° Celsius per hour until the body nears ambient temperature.

The Glaister equation[1][2] estimates the hours elapsed since death as a linear function of the rectal temperature:

[pic]

CLOTHING [AND PERSONAL EFFECTS]:

The following clothing items [and personal effects] are (examined separately from the body, on the body) at the time of examination:

• Bulleted list

MEDICAL INTERVENTION:

• Bulleted list

RADIOGRAPHS:

Postmortem radiographs of the _____ demonstrate ________.

WEAPON:

LIGATURE:

EVIDENCE OF INJURY:

[All external and internal injuries go here]

Subtitle 1:

Subtitle 2:

INTERNAL EXAMINATION:

[DO NOT LIST OR RE-DESCRIBE INJURIES HERE]

HEAD: The subcutaneous scalp, galea and subgaleal soft tissues are free of injury. The calvarium is intact, as is the dura mater beneath it. Clear cerebrospinal fluid surrounds the _____ gm brain, which has unremarkable gyri and sulci. Coronal sections demonstrate sharp demarcation between white and grey matter, without hemorrhage or contusive injury. The ventricles are of normal size. The basal ganglia, brainstem, cerebellum, and arterial systems are free of injury or other abnormalities. There are no skull fractures. The atlanto-occipital joint is stable.

NECK: The anterior strap muscles of the neck are homogenous and red-brown, without hemorrhage. The thyroid cartilage and hyoid are intact. The larynx is lined by intact white mucosa. The thyroid is symmetric and red-brown, without cystic or nodular change. The tongue is free of bite marks, hemorrhage, or other injuries. There is no soot staining of the larynx or trachea.

BODY CAVITIES: The ribs, sternum, and vertebral bodies are visibly and palpably intact. No excess fluid is in the pleural, pericardial, or peritoneal cavities. The organs occupy their usual anatomic positions.

RESPIRATORY SYSTEM: The right and left lungs weigh __ and __ gm, respectively. The external surfaces are [description.] The pulmonary parenchyma is [description.] No mass lesions or areas of consolidation are present. The pulmonary vascular tree is free of thromboemboli. The bronchi are [free of blood, vomitus, foreign material, foamy edema, etc.]

CARDIOVASCULAR SYSTEM: The __ gm heart is contained in an unremarkable pericardial sac. The epicardial surface is smooth, with [quantitative estimate] fat investment. The coronary arteries are present in a normal distribution, with a _____-dominant pattern. Cross sections of the vessels show _______. The myocardium is (homogenous, red-brown, and firm; infarcts, etc.). The valve leaflets are thin and mobile. The walls of the left and right ventricles are ___and _____-cm thick, respectively. The endocardium is smooth and glistening. The aorta gives rise to three intact and patent arch vessels. The renal and mesenteric vessels are unremarkable.

LIVER & BILIARY SYSTEM: The _____ gm liver has an intact, smooth capsule and a sharp anterior border. The parenchyma is tan-brown and congested, with the usual lobular architecture. No mass lesions or other abnormalities are seen. The gallbladder contains a [quantitative measurement or qualitative estimate] amount of green-black bile and no stones. The mucosal surface is green and velvety. The extrahepatic biliary tree is patent.

SPLEEN & HEMATOPOIETIC SYSTEM: The __ gm spleen has a smooth, intact, red-purple capsule. The parenchyma is maroon and congested. No enlarged lymph nodes are identified. Bone marrow, where exposed by the autopsy procedure, is unremarkable.

PANCREAS: The pancreas is firm and yellow-tan, with the usual lobular architecture. No mass lesions or other abnormalities are seen.

ADRENALS: The right and left adrenal glands are symmetric, with bright yellow cortices and grey medullae. No masses or areas of hemorrhage are identified.

GENITOURINARY SYSTEM: The right and left kidneys weigh _____ and _____ gm, respectively. The external surfaces are [description]. The cut surfaces are red-tan and congested, with uniformly thick cortices and sharp corticomedullary junctions. The pelves are unremarkable and the ureters are normal in course and caliber. White bladder mucosa overlies an intact bladder wall. The bladder contains approximately [quantitative measurement] cc of [color] urine. [The prostate is normal in size, with spongy, yellow-tan parenchyma. The seminal vesicles are unremarkable. The testes are free of mass lesions, contusions, or other abnormalities]. [The uterus, fallopian tubes, ovaries, cervix, and vaginal vault are without injury or other abnormalities. There is no evidence of pregnancy].

GASTROINTESTINAL TRACT: The esophagus is intact and lined by smooth, grey-white mucosa. The stomach contains [quantitative measurement] cc of [description of gastric contents]. The gastric wall is intact. The duodenum, loops of small bowel, and colon are unremarkable. The appendix is [present/absent].

ADDITIONAL PROCEDURES:

• Documentary photographs are taken.

• Specimens retained for toxicologic testing: [list – the standard specimens would be blood, vitreous, liver, urine, and gastric contents]

• The recovered projectile(s) is/are photographed and placed in a labeled, sealed evidence envelope(s)

• Fingernail clippings are placed in labeled, sealed envelopes

• Pulled head hairs are placed in labeled, sealed envelope

• Appropriate specimens for a sexual assault kit are placed in a labeled, sealed box

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