EFTA00161513 # (U) OCME Epstein Autopsy Report ## FINAL DIAGNOSES: I. HANGING: A. LIGATURE FURROW OF NECK B. PETECHIAL HEMORRHAGES OF BILATERAL PALPEBRAL CONJUNCTIVAE AND OF ORAL MUCOSA C. CONFLUENT HEMORRHAGES OF RIGHT BULBAR CONJUNCTIVA D. PLETHORA OF FACE AND HEAD WITH PETECHIAL HEMORRHAGES OF FACE E. FRACTURES OF BILATERAL THYROID CARTILAGE CORNUAE AND LEFT HYOID CORNUA WITH ACCOMPANYING SOFT TISSUE HEMORRHAGES 1. SEE ANTHROPOLOGY REPORT F. RESUSCITATION ATTEMPTED 1. ABRASIONS OF MOUTH 2. ANTERIOR PARASTERNAL RIB FRACTURES 3. HEPATIC LACERATION WITH THIN HEMOPERITONEUM II. ABRASIONS OF LEFT FOREARM III. CUTANEOUS CONTUSIONS OF WRISTS IV. SUBCUTANEOUS HEMORRHAGE OF LEFT DELTOID MUSCLE V. HYPERTENSIVE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE A. CARDIAC HYPERTROPHY (440 GM) B. LEFT VENTRICLE HYPERTROPHY (1.9 CM) C. RENAL ARTERIOLAR SCLEROSIS D. SLIGHT CORONARY ATHEROSCLEROSIS E. SLIGHT TO MODERATE AORTIC ATHEROSCLEROSIS VI. HEPATIC STEATOSIS (2480 GM) VII. CERVICAL LYMPHADENOPATHY IX. REMOTE APPENDECTOMY (DATE AND INDICATION UNKNOWN) VIII. REMOTE FRACTURE OF RIGHT FIRST RIB X. SEE TOXICOLOGY REPORT XI. SEE NEUROPATHOLOGY REPORT UNCLASSIFIED
CAUSE OF DEATH:HANGING
MANNER OF DEATH:SUICIDE (HANGED SELF)
New York City Office of Chief Medical Examiner I certify the attached are true copies of document(s) in OCME's possession. | Name | Date | | :--- | :--- | | Welisse Matias | 8/28/17 | EFTA00161514 # (U) OCME Epstein Autopsy Report Continued CLOTHING: The body is received clad in a hospital gown. ## INJURIES, EXTERNAL AND INTERNAL: These injuries are described in reference to standard anatomic planes. These injuries are grouped and labeled for descriptive purposes only; no sequence is implied. ## A. HANGING: There is a depressed, focally dried and abraded, noncircumferential ligature furrow of the neck that peaks slightly on both sides of the neck, more steeply on the right side than on the left. On the right side of the neck, the furrow bifurcates anterior to the ear, with one arm that peaks behind the right ear and one arm that extends to the right side of the back of the neck. On the back of the right side of the neck at the end of the lower arm of the furrow is a 1/2" x 1", irregular, red abrasion. The furrow ranges from 13-3/4" to 15" long (measured from both ends of the furrow on the right), and ranges from 1/8" to 1/2" wide. Anteriorly, the furrow passes over the thyroid cartilage. On the upper edge of the right side of the furrow beneath the chin is an adjacent, ¾ x 1", inverted V-shaped, linear abrasion that ranges in width from 1/8" to 1/4". Beneath the left side of the mandible is a faint, 1/2" x 1-3/4", irregular, red abrasion with multiple, interspersed, deeper, red abrasions that measure up to ¼ x 3/8". The face and head are plethoric above the furrow, with petechial hemorrhages of the face that are most marked within the eyebrows. There are multiple, petechial hemorrhages of the palpebral conjunctivae of both eyes, and confluent hemorrhages on the periphery of the right bulbar conjunctiva. There are faint petechial hemorrhages on the mucosal surfaces of the upper and lower lips. Within the parenchyma of the tongue are multiple, focal, spotty, purple hemorrhages. There is diffuse, purple hemorrhage at the base of the tongue. There are no hemorrhages of the anterior strap muscles of the neck. Posteriorly, there is a single hemorrhage in the left, deep, paraspinal muscles. Both thyroid cartilage cornuae are fractured, and the left cornua of the hyoid bone is fractured, all with accompanying soft tissue hemorrhages. See also "Anthropology Report." There are no fractures of the cervical vertebrae. ## B. OTHER INJURIES; On the back of the left forearm is an oblique, 1" , linear, red, abrasion with an adjacent, 1/2" x 1-1/4", faint, red abrasion. On the medial aspect of the back of the right wrist is a 1/8" x 1/2", faint, red contusion, and on the medial aspect of the back of the left wrist is a UNCLASSIFIED EFTA00161515 # (U) OCME Epstein Autopsy Report Continued ## Larynx The thyroid cartilage is almost entirely ossified and the cricoid cartilage is partially ossified. The thyroid exhibits two fractures: one to the left superior horn and one to the right superior horn (Figures 1 and 3). The fractures to both the left and right superior horns occur just superior to the junction with the lamina. The cricoid does not exhibit any fractures. Figure 3. Microscopic (10x) posterior views of fractures (white circles) to the left and right superior horns of the thyroid. ## SUMMARY: The hyoid bone exhibits a fracture of the left greater horn. The thyroid exhibits two fractures: one to the right superior horn and one to the left superior horn. ## BACKGROUND: On 12 August 2019, the Forensic Anthropology Unit received a hyoid and larynx that were removed by Dr. Kristin Roman during the autopsy of a 66-year-old male and submitted for a trauma analysis. The hyoid was cleaned in warm water and a combination of sodium bicarbonate and enzyme detergent. The larynx was placed in formalin and the soft tissues of the thyroid and cricoid were manually removed to facilitate examination. The specimens were examined radiographically, macroscopically and microscopically. Figure 1. Diagram of the submitted hyoid and larynx (anterior view) showing the approximate fracture locations (red lines). Figure 2. Overview of the submitted hyoid bone exhibiting a fracture to the left greater horn (white arrow). ## FINDINGS: ## Hyoid The greater horns of the hyoid are bilaterally fused to the hyoid body. There is a fracture of the left greater horn (Figures 1 and 2). The Forensic Anthropology Unit is accredited in Forensic Inspection under ISO/IEC 17020 issued by ANSI National Accreditation Board. Refer to certificate and scope of accreditation FI-0014. UNCLASSIFIED EFTA00161516