Just my opinion, but I dont think the marks on JonBenets legs are from petechial hemorrhaging -- at least not related to the strangulation. Hopefully the following information will be helpful in understanding why, and maybe even contribute to understanding a little better about the petechiae that
were found on her body.
First, I should warn anyone reading this to not be thrown off by some of the following quotes from sources that pertain to suspension or hanging simply because you disagree with that possibility. Understand that as far as development of petechiae, the only difference between manual ligature strangulation and ligature suspension is the cause of the pressure (one being the result of an assailant pulling the ligature, and the other being the victims own weight pulling the ligature from a fixed object). Except for a few details, most of the injuries to the victim will be the same in either case, so looking at information from both CODs is valuable.
http://www.ncdsv.org/images/strangulation_article.pdfThe tiny red spots (petechiae) characteristic of many cases of strangulation are due to ruptured capillariesthe smallest blood vessels in the bodyand sometimes may be found only under the eyelids (conjunctivae). However, sometimes they may be found around the eyes in the periorbital region, anywhere on the face, and on the neck in and above the area of constriction. Petechiae tend to be most pronounced in ligature strangulation. Blood red eyes (subconjunctival hemorrhages) are due to capillary rupture in the white portion (sclera) of the eyes.
http://www.forensicmed.co.uk/wounds/blunt-force-trauma/bruises/Their (petechial hemorrhages) pathogenesis is poorly understood, but may relate to raised intra-capillary pressure due to an obstruction of venous return (subsequent to pressure applied to the upper chest or neck, for example), hypoxia, endothelial dysfunction (in sepsis) or a combination of these factors (Jaffe 1994). Petechiae can also be caused by blunt trauma (Jaffe 1994, Saukko and Knight 2004), implying a mechanical disruption of capillaries.
Despite some contention that other physiological changes in cellular structure (
hypoxic injury to endothelial cells caused by venous stasis and tissue acidosis) may also have a minor influence on the likelihood of petechial development (particularly in non-asphyxial deaths), it remains most commonly accepted as a purely mechanical response to increased pressure causing the rupture of capillaries. This continued belief by some is, in part, because petechiae are known to be a result of other purely metabolic causes where an existing condition can cause petechiae and purpura. Some of those metabolic causes are vasculitis, meningitis, typhus, scurvy, platelet disorders, and radiation poisoning. This (IMO) is not applicable in the case of strangulation because of the amount of time required for metabolic changes to occur at the cellular level. The generally accepted belief that petechiae (in the case of strangulation/suspension) are the result of a purely mechanical response is explained in the following article:
Asphyxial Deaths and Petechiae: A Review (Susan F. Ely, M.D., M.P.H. and Charles S. Hirsch, M.D),
Journal of Forensic Science, 2000, 45(6):12741277
Reprinted online:
http://www.charlydmiller.com/LIB04/2000petechiaereview.pdfExcluding those related to infectious, coagulopathic, or microembolic etiologies, we conclude that petechiae of the head are the product of purely mechanical vascular phenomena: namely, impaired or obstructed venous return in the presence of continued arterial input. As pressure builds in venules and capillaries, particularly those with little surrounding connective tissue support, such as the conjunctivae and eyelids, vascular rupture produces petechiae. The likelihood of this occurrence is directly proportional to the degree of venous obstruction and inversely proportional to that of arterial compression at or above the level of the heart. Nearly 4.5 lb (2 kg) of pressure is required to compress the jugular veins, whereas 11 and 66 lb (5 and 30 kg) are required to compress the carotid and vertebral arteries, respectively; therefore, an intermediate amount of force simultaneously applied to both results in venous compression before arterial. This is similarly applicable to the right and left sides of the heart. If the compressive pressure to the chest or neck is great enough to obstruct venous return from the head, but not enough to obstruct arterial flow to it, cephalic (related to the head) venous pressure will rise, as will the probability of small vessel rupture. A violent struggle that increases cardiac output and raises blood pressure therefore enhances the occurrence of petechiae. Alternatively, if the applied force is sufficiently great to obstruct arterial flow, venous engorgement and rupture will not occur. An analogous mechanism resulting in elevated cephalic venous pressure without compression occurs with a precipitous impairment of venous return to the heart, such as that seen in acute right heart failure.
From Petechiae in Hanging, A Retrospective Study of Contributing Variables (Renaud Clément, MD, Jean-Pierre Guay, PhD, Margaret Redpath, MD, and Anny Sauvageau, MD, MSc):
http://arsh.lmo.ir/wp-content/uploads/2013/10/2011.4.21.pdfAn 8.5-year retrospective study of 206 cases of death by hanging reviewed autopsy reports for the presence of petechiae. For each case, the following information was also compiled: gender and age, height and weight, body mass index, the type of hanging (complete or incomplete suspension), the type of ligature used (narrow or wide), and whether or not the victim had received cardiopulmonary resuscitation maneuvers. Statistical analysis revealed that the incidence was higher among incomplete hanging victims compared with cases of complete suspension and that the incidence of petechiae varied inversely with the height of the victims. The other factors were not shown to contribute significantly to the presence of petechiae.
The present study is intended to contribute to EBM (evidence-based medicine) by evaluating the relationship between petechiae and the type of hanging (complete vs. incomplete). Several other variables such as victims age, height, weight, the body mass index (BMI), type of ligature, and cardiopulmonary resuscitation were analyzed to determine if they contribute significantly to the presence of petechiae.
Petechiae are pinpoint hemorrhages resulting from the rupture of small vessels. In hanging, mechanical obstruction of venous return to the heart causes an increase in intravascular pressure that induces overdistention of the thin-walled peripheral venules and this can lead to rupture. The venules located in areas that are low in connective tissue, such as the conjunctiva and sclera of the eyes, the skin of the upper eyelid, the forehead, behind the ears, and around the mouth are more prone to rupture.
Despite the fact that the presence of petechiae is considered one of the classic signs of asphyxia, petechiae are not commonly observed in cases of hanging. In such cases it is believed that the total occlusion of both the arterial and venous supply creates a stabilization, rather than an increase, in intravascular pressure in the head. In keeping with this, it is often stated in the literature that petechiae are more frequently observed in cases of hanging where part of the body is supporting the victims weight, ie, cases of incomplete hanging, because it is believed that the jugular veins become occluded while the deeper and less compressible carotid and vertebral arteries remain patent.
Incidence of Petechiae in Relation to the Type of Hanging
It is often stated in forensic textbooks that the incidence of petechiae in hanging with incomplete (partial) suspension of the body is higher than in hanging with complete free suspension. In incomplete hanging, occlusion of the venous return can occur without a disruption of arterial supply. Because the deeper and less compressible arteries remain patent while venous drainage is blocked, the persistence of arterial circulation generates high intravascular pressure in the head and neck.
The differential pressure between arteries and veins is demonstrated with a test mentioned in the above article. Known by different names (Rumpel-Leede Capillary-Fragility Test, capillary fragility test, tourniquet test, Hess test), it was used in the past to test for certain diseases and conditions. Basically it is done by constricting blood circulation in the arm between the levels measured in a blood pressure test (systolic and diastolic) for a proscribed length of time. This allows arterial pressure buildup while restricting venous flow. The resulting higher venous pressure causes petechial hemorrhages to appear on the limb on the side of the restriction opposite the heart. The number of petechiae are then counted within a measured area. A higher than normally expected number indicates a weaker capillary structure in the person.
http://en.wikipedia(dot)org/wiki/Tourniquet_test
http://en.wikipedia(dot)org/wiki/Hess_test
http://www.pathology.vcu.edu/education/PathLab/pages/hemostasis/cotests/capillaryfragility.html
Whether you realize it or not, each of us has most likely experienced petechial hemorrhaging at some time in our lives. If you ever received (or gave) a passion mark (hickey, sucker bite, love bite), its appearance is because of the capillaries (or venules) bursting below the surface of the skin. If youve ever been struck or scraped by an object that left a reddish mark on the surface of the skin without breaking the skin, its color is from the surface capillaries that experienced momentary excessive pressure and burst. A similar reaction can be found if something is pressed down on the skin and then moved along the surface in a scraping motion. Here it forces the capillary blood out from under the object and into the adjacent capillaries, causing the buildup of pressure to be enough to burst the engorged blood vessels. So the petechial hemorrhaging seen in strangulations is not something unique to strangulations alone. They can also be found on internal organs (usually on their surface) during the autopsy of someone with certain medical conditions -- or who died under traumatic circumstances such as asphyxiation.
The only reason all this is important to us is so we understand exactly what the petechiae on JonBenets neck represents. If the position of the furrow on JonBenets neck was where she was initially strangled, there should be little or no petechiae below it. But there is. There is enough of an area that simply reading the AR should be enough (without the additional benefit of seeing it on the leaked autopsy photos) to tell us the ligature found on her neck was somewhere else in a lower position while she was still alive, or that another ligature was also used and then removed. Dr. Wecht saw this. Thats why he came up with the idea (mistakenly, IMO) that it was part of a sex game gone awry where the ligature was repeatedly tightened and then loosened. All these indications of ligature strangulation are especially important in cases where someone is killed with a ligature that has been removed from the body before it is discovered. It tells medical examiners how the victim was killed and what might have been used -- even if there is no ligature remaining on the body and no ligature furrow formation due to the length of time it may have remained on the body before being removed.
(The following two paragraphs are IMO only):
If we consider all this along with the possibility (
probability, IMO) that the other location of the ligature is also shown by the blanched white line below her laryngeal prominence (Adams apple, or thyroid cartilage), we get a more defined picture of what actually happened. The ligature was initially tied loosely around her neck. A sudden jerk or pulling of the cord caused it to tighten in the lower position where it remained until she was dead or dying. The projection of the white line indicates the direction it was pulled. Then (as is not unusual in accidental hangings and some intentional strangulations) the weight of the body pulling down on the cord caused it to overcome the obstruction of the laryngeal prominence, rolling over the skin of the neck aggravating the number of individual petechiae, allowing it to further tighten and then stop below the chin.
If this was indeed the result of a suspension (as I believe) and she had remained in this position, the ligature would have formed a slightly different appearing furrow than was found. It would have been more prominent in the front of her neck than the back (because of the pressure of weight distribution), and there might have been the familiar inverted V where the knot was located. But instead, once the weight of her body was removed, the pressure of the ligature equalized around her neck into the circumferential location found when her body was examined. Because her body was not left suspended for a long enough period of time, the appearance that would be expected from it is not there -- only indications of it that cant be explained adequately by other theories.
A few more points from
http://forensicpathologyonline.com/e-book/asphyxia/hanging:
Frequently, only the portion adjacent to the knot moves. There is a tendency for the ligature to move upwards, this being limited by the jaws. The upward movement may produce double impression of ligature. The lower mark is usually very superficial and is connected by fine abrasions, caused by the slipping ligature, to the mark made by ligature in its final position
The ligature produces a furrow or groove in the tissue which is pale in colour, but it later becomes yellowish or yellow-brown and hard like parchment, due to the drying of the slightly abraded skin.
A slip-knot may cause the noose to tighten and squeeze the skin through the full circumference of the neck.
The mark is seen on both sides of the neck, and is usually directed transversely across the front of the neck resembling that of a ligature mark in strangulation, except that it is likely to be seen above the level of thyroid cartilage.
In partial hanging when the body leans forward, a horizontal ligature mark may be seen.
When fresh, the ligature mark is less clear, but becomes prominent after dying for several hours.
The tongue is usually swollen and blue especially at the base, and usually forced against the teeth when the jaw is shut, or the tip may be found projecting between the lips. The protruding part of the tongue is usually dark-brown or even black due to drying. (Remember the slight drying artifact of the tip of the tongue in JonBenets AR?)
Saliva may be found dribbling from the angle of mouth when the head is drooping forward. This is due to the increased salivation before death due to the stimulation of the salivary glands by the ligature. Slight haemorrhage or bloody froth is sometimes seen at the mouth and nostrils, and some blood may be found under the head.
In most cases, there is no bruising of strap muscles or other soft tissues, the muscles of the neck, especially the platysma and sternomastoid are ruptured (5 to 10%), if violence has been considerable. In some cases (5 to 10%), the intima of the carotid arteries show transverse splits with extravasation of blood in their wall due to stretching and crushing.
The vertebral arteries show rupture, intimal tears, and subintimal haemorrhages in some cases (not addressed by Meyer in the AR).
Maybe looking at all the injuries on JonBenets neck and trying to interpret them is like reading tea leaves. But as much as I respect the knowledge and opinion of some of the familiar medical experts, I dont think theyve yet figured out exactly what happened.