Since the 8-year-old child’s cause of death was unknown, her body was admitted to the morgue for a post mortem study.
External examination
Clothes
No clothes were present on the body.
External appearance
The body was that of a female Saudi child with a 140 cm height and a typical body build and weight for her age. Rigor mortis was present although affected by refrigeration. A red hue of hypostasis was noted on her back but did not involve the pressure areas. There were no signs of decomposition.
Head and neck
No injuries were seen in the head and neck area (Fig. 1). When the face was looked at, there were no broken bones; both eyes were congested and free of injuries; there were no injuries or foreign objects in the nose or nostrils, and there was no rhinorrhea. The lips and mucous membrane were free from injuries.
Chest, abdomen, back and pelvis
Bruising was evident in the chest centre (Fig. 2). Needle marks were obvious on either side of the femoral triangle (Fig. 3). These findings were consistent with clinical procedures. No injuries were observed on the abdomen or back.
Upper limbs
A red, circular bruise, 3 cm in diameter, was present on the left shoulder, relating to clinical procedures (Fig. 4). Numerous puncture wounds relating to clinical procedures were seen on the back of both hands (Fig. 5), wrists (Fig. 6) and forearms, the latter 3 cm inferior to the cubital fossae (Fig. 7).
Lower limbs
A needle mark, associated with a clinical procedure, was identified on the lateral side of the left ankle (Fig. 8). The lower limbs were otherwise of a normal appearance.
Autopsy
Head
No bruising was observed in the reflected layers of the scalp. No injuries were noted on the calvarium or skull, and no intracranial bleeding was identified. The brain appeared symmetrical but was increased in size, weighing 1700 g, and there was evident oedema and congestion. The definition of the gyrae was lost, and the sulcus was narrowed (Fig. 9). On dissection, the third ventricle was found to contain a cyst, which was filled with a mucoid substance, yellow-green in colour (Fig. 10).
Face and neck
No injuries were present on the face, and no haemorrhages were identified within the muscles in the cervical region.
Chest and abdomen
An incision was made in the midline which extended between mental and pubic symphyses. Exposure of the thoracic wall and rib cage showed the structures to be intact without any bruising or fractures. The lungs were of normal dimensions and appeared outwardly normal. The cardiac structures were also normal; no congenital anomalies were seen, and the coronary arteries were free from obstruction. No bruising was evident within the abdominal wall; the organs within the abdominal cavity had a normal external appearance.
Histopathological samples
A complete set of pathological specimens was obtained, which included samples from the cerebral cyst and third ventricle. The findings are detailed below.
Brain
The presence of a cyst, filled with a mucoid substance and with a simple epithelial lining, was confirmed. A colloid cyst was queried (Fig. 11 a and b). Cerebral oedema was reported.
Heart
The heart was normal in shape and size with no congenital anomalies. All heart valves were free of congenital malformations or pathological diseases. Two coronary ostia were found, and both were anatomically normal. The heart ventricles wall thickness was normal, with the left one measuring about 1.8 cm.
Lungs, liver, kidneys, spleen and suprarenal glands
Congestion was noted in these viscera.
Toxicology samples
Specimens of blood and serum were taken for toxicological analysis, which included alcohol, narcotics, toxins and illicit substances; the results were negative in all cases.