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Paltauf Hemorrhage: Causes, Symptoms [Forensic Medicine]

Paltauf Hemorrhages seen in

In this post, we had listed down the causes, signs, color, and mechanism of Paltauf Hemorrhage along with frequently asked questions.

What is Paltauf Hemorrhage?

Hemorrhages on the anterior surface of the lungs, present subpleurally with shining pale pink or bluish-red in color, usually of 1cm to 2cm in diameter are called Paltauf hemorrhages. They are present mostly on the lower lobes on the anterior surface and margins of the lungs.

In short, these hemorrhages refer to subpleural hemorrhages which are seen in case of drowning.

What are the Other Names of Paltauf’s Hemorrhages?

Other names are listed as:

  • Paltauf’s Spots
  • Rasskazov-Lukomskij spots (in literature)

What is the Color of Paltauf Hemorrhage?

There are two color variants of paltauf spots which, for obvious, depending on the type of downing:

  • Pink Color: In freshwater drowning, the pinkish color is due to hemolysis in which higher sodium content of the blood.
  • Bluish Red (purplish) Color: seen in saltwater drowning

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Who Discovered Paltuaf’s Hemorrhages?

In 1888, it was described by Arnold Paltauf in the publication named “U¨ber den Tod durch Ertrinken”. He was an Austrian medical examiner working as a professor at Charles-Ferdinand University in Prague. And that’s why the name Paltuaf’s hemorrhages.

However, in 1869, literature named “O pjatnach Tardmje pri zadusˇenii”, first described as Rasskazov-Lukomskij spots (on the name of two authors)
[Source: ResearchGate].

Paltauf Hemorrhage Seen in Which Lung’s Part?

The occurrence of these hemorrhages are:

  • Majorly seen on: Lower lobes of lungs (about 50%)
  • Also seen on: anterior surfaces of lungs and interlobar surfaces

What is the Cause of Paltauf’s Hemorrhage?

These hemorrhages are due to the effused blood from the tracking along the interlobular septa.

This effusion of blood is because of the rupture of the intra alveolar walls, resulting of forced expirations. 

Mechanism of Paltauf Hemorrhages in Drowning

Let’s say, person A, fell from a boat into the freshwater lake and drowned to death.

As the water enters the lungs, there is a presence of watery froth (with or without blood-stained fluid).

The formation of froth with blood-stained is due to the penetration of water into the alveolar walls and finally to tissues and blood vessels. The formation of froth is common, and waterlogged lungs are medically called Emphysema Aquosum.

Note: Edema Aquosum: Waterlogged in air sacs which makes the lungs doughy, readily pits on pressure, exuding water and froth. However, if the person is unconscious, there is merely-to-no froth formation (because of any fluid in the lungs), termed as Oedema Aquosum.

With the filling fluid to the lungs, there are more powerful inspiratory efforts and less expiratory efforts that result in doughy lungs.

With an increase in pressure during the forced expiration, the hemorrhage’s diameter becomes wider.

When these hemorrhages appear subpleural, majorly in the lower lobes of the lungs (but also seen in the anterior surface of the lungs, and the interlobar surfaces), results in mottled areas with red distended alveoli patches of 1cm to 2cm long which is called Paltauf’s hemorrhages.

Paltauf Hemorrhages are Commonly Seen in Antemortem Drowning or Postmortem drowning?

Paltauf spots are commonly seen in antemortem drowning because of the filling of water in the lungs and forced expiration. This is all possible when the person is conscious

Conversely, if the person is unconscious (dead before drowning), there is merely any water to cause hemorrhages on the anterior lower lobes of the lungs.

What are the Signs and Symptoms of Paltauf Hemorrhage?

The common signs, symptoms, and characteristics of Paltauf Hemorrhage in drowning are:

  1. 1 cm to 2 cm wider spots
  2. Pale pinkish or blue-red color spots
  3. Seen majorly in the lower lobes on the anterior surface of lungs
  4. Sign of antemortem drowning.
  5. Sign of wet drowning.
  6. Larger subpleural hemorrhages of 1 cm to 2 cm, because of the rupture of intra-alveolar partitions beneath the pleura of the lungs.

Note: Wet Drowning is due to inhalation of water that interferes with respiration and finally becomes the reason for the collapse of the circulatory system.

Tardieu Spots Vs Paltauf Spots

Tardieu’s spots are due to the ruptured capillaries majorly by compression which is usually minute punctiform (point) hemorrhages. Moreover, these are largely seen in cases where some mechanical pressure is used to constrict the neck, and very rare in drowning.

On the other hand, paltauf hemorrhages are on the anterior lower lobes of the lungs.

 Tardieu SpotsPaltauf Spots
Due toRupture of capillaries because of constriction Rupture of intra-alveolar partitions beneath pleura
Acting forceCompression of ligature (or same)Forced expiration
Usually Seen inHangingWet Drowning
ColorDark pinpoint spotsPale pink or blue-red spots

Check Your Knowledge With MCQs

Click on “Answer and explanation” to know more about the topic.

A. Paltauf’s hemorrhage seen in:

  1. Antemortem Drowning
  2. Postmortem drowning
  3. Hanging
  4. Strangulation

Answer: (1) Antemortem Drowning

Explanation:
-> Because waterlogged lungs and forced expiration are seen in antemortem drowning.

B. Paltauf hemorrhage seen in ___________ drowning:

  1. Dry Drowning
  2. Wet Drowning
  3. Atypical Hanging
  4. Choking

Answer: (2) Wet Drowning

C. Paltauf’s hemorrhage is seen in which part of the lungs?

  1. Lower lobes of lungs
  2. Interlobar surface
  3. Larynx
  4. Both (1) and (2)

Answer: (4) Both (1) and (2)

D. Paltauf’s Hemorrhage is on the name of which professor?

  1. Williams Paltauf
  2. Arnold Paltauf
  3. Andrew Paltauf
  4. Austin Paltauf

Answer: (2) Arnold Paltauf

Explanation:
He was an Austrian medical examiner working as a professor at Charles-Ferdinand University in Prague.

Reference Books:

  • Textbook of Forensic Medicine and Toxicology: Principles and Practice by Krishnan Vij
  • The Essentials Of Forensic Medicine And Toxicology by Reddy K.S. Narayan

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