Bordoni; Leonardo Santos. Médico-legista do Instituto Médico Legal de Belo Horizonte, Professor da Faculdade de Medicina de Barbacena. Telefone: (31) 99973-0806. E-mail: leonardosantosbordoni@gmail.com.
Bordoni; Polyanna Helena Coelho. Médica-legista do Posto Médico Legal de Ribeirão das Neves.
Souza; João Paulo Rodrigues. Estudante de graduação da Faculdade de Medicina de Barbacena.
Pereira; Lucas Soares. Estudante de graduação da Faculdade de Medicina de Barbacena.
Hermuche; Marcos de Castro. Estudante de graduação da Faculdade de Medicina de Barbacena.
Reis Filho; Ricardo José Pinheiro. Estudante de graduação da Faculdade de Medicina de Barbacena.
Oliveira; Túlio Ribeiro. Estudante de graduação da Faculdade de Medicina de Barbacena.
Introdução: As petéquias são hemorragias puntiformes na pele, serosas ou mucosas, causadas por rupturas de pequenos vasos (em especial vênulas), que podem ocorrer em várias situações ou doenças. A literatura especializada enfatiza que não há associação entre mortes violentas, incluindo as asfixias, com a produção de petéquias, sendo estas explicadas unicamente pelo mecanismo de aumento da pressão venular, independente da causa desta. Entretanto, as petéquias continuam na prática sendo associadas a situações de asfixia. Tendo em vista as controvérsias sobre o significado das petéquias em necropsias forenses este estudo objetivou verificar sua prevalência e associação com diferentes causas de morte.
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Metodologia: Estudo retrospectivo, transversal, dos laudos de necropsias do Instituto Médico Legal de Belo Horizonte (IML-BH) no período de 2006 a 2012. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Fundação Hospitalar de Minas Gerais (CAAE 62561816.7.0000.5119).
Resultados: Petéquias foram descritas em 6,3% dos 40.984 laudos analisados. A maioria foi observada em homens, menores de 35 anos e de cor parda. O trauma foi a causa da morte predominante entre os necropsiados com petéquias, destacando-se as asfixias (70% dos casos de trauma com petéquias), em especial as produzidas por constrição cervical. Foram mais frequentes nas mortes traumáticas que nas naturais ou nas de causa indeterminada e mesmo quando foram comparados apenas os casos de morte traumática não asfíxica com os de causa natural ou indeterminada, encontrou- se mais petéquias naquele grupo. O tórax foi a região anatômica onde foram observadas com maior frequência (96,8%), em especial nas serosas do coração e dos pulmões, e vários necropsiados apresentaram petéquias em mais de uma região anatômica. Não houve associação entre a presença de petéquias e a positividade para álcool etílico, fármacos ou drogas de abuso.
Conclusão: Os dados do IML-BH não respaldam a interpretação que dissocia a ocorrência das petéquias com causas violentas de óbito, indicando que seu mecanismo de produção é multifatorial, não podendo ser exclusivamente atribuído ao aumento da pressão venular, mas também envolvendo um contexto de hipóxia tecidual ou mesmo outros mecanismos ainda não esclarecidos.
Referências bibliográficas
- SAUKKO, Pekka; KNIGHT, Bernard. Suffocation and ‘Asphyxia’. In: Knight’s Forensic Pathology. 4th ed. Boca Raton: CRC Press, p. 353-368, 2016.
- SPITZ, Werner. Asphyxia. In: SPITZ, Werner; SPITZ, Daniel (Eds). Spitz and Fisher’s Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation. 4th ed. Springfield: Charles C Thomas, p. 783-845, 2006.
- CLÉMENT, R et al. Petechiae in Hanging – A Retrospective Study of Contributing Variables. The American Journal of Forensic Medicine and Pathology, v. 32, n. 4, p. 378-382, 2011.
- ELY, SF; HIRSCH, CS. Asphyxial deaths and petechiae: a review. Journal of Forensic Sciences, v. 45, p. 1274 –1277, 2000.