The presence of pneumomediastinum and cervical soft tissue emphysema may be evidence of death by hanging. These findings can be subtle and can be missed unless imaging studies (CT or MRI) are performed.
Analysis: postmortem CT or MRI
Criteria for hanging as the cause of death - both of the following:
(1) presence of air in mediastinum and cervical soft tissue
(2) exclusion of putrefactive gas formation
Factors used to exclude putrefactive gas formation:
(1) negative post-mortemblood alcohol (to exclude post-mortem alcohol formation, but this should not exclude someone hanging himself while intoxicated)
(2) absence of intravascular gas
(3) absence of soft tissue gas above the ligature (with death by hanging the upper limit of the cervical soft tissue emphysema is the strangulation mark)
(4) absence of soft tissue gas in other parts of the body
The absence of pneumomediastinum and cervical soft tissue emphysema following an apparent strangulation may indicate a post-mortem staging.
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