Korean J Leg Med.  2019 Feb;43(1):16-22. 10.7580/kjlm.2019.43.1.16.

Are Wischnewski Spots Found Only in Hypothermia?

• Noh MK
• Lee S

• KMID: 2440394
• DOI: http://doi.org/10.7580/kjlm.2019.43.1.16

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.

Keyword

Wischnewski spots; Hypothermia; Autopsy

MeSH Terms

Alcoholism
Autopsy
Cause of Death
Diagnosis
Forensic Medicine
Gastric Mucosa
Gyeongsangbuk-do
Humans
Hypothermia*
Korea
Neutrophil Infiltration
Pesticides
Pigmentation
Poisoning
Pesticides

Figure

• 

  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).

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