Marked congestion (blood pooling) of the head and upper chest — Congestion means an accumulation of blood. When the head and chest appear dark purple then they are said to be congested because blood has backed up into these areas. This an indication the heart has failed, usually suddenly. The most common cause is heart disease, especially coronary artery disease, however, any type of heart disease may cause this finding. Other diseases such as seizures, pulmonary thromboemboli (blood clots in the lungs) and asthma to name a few can cause this process. Unnatural causes such as an overdose or suffocation may also be the cause.
Jaundice — This is yellowish discoloration of the skin which can be seen in either liver disease, infection (septicemia), or the breakdown of blood. The whites of the eyes may be yellow (icterus) and be the first sign of this process.
Bruising — This is a sign of trauma, however, all bruises should not be considered suspicious. Elderly individuals bruise easily and they usually have areas of bleeding (ecchymoses) on the forearms and hands. This does not mean the individual was abused by someone else.
Unkempt condition — General uncleanliness may be due to alcoholism, drug abuse, or a mental disorder.
Condition of the clothing — The type of clothing may help indicate the time of death.
Living conditions — The condition of the apartment or house may give an indication of alcoholism or drug abuse. Of course, the person could just be a slob.
Muscle wastage — (see Cachexia).
Cachexia — Generalized muscle wastage; the "concentration camp" look. This may be seen in any end stage (terminal) chronic disease. However, this appearance should not be present in someone not expected to appear as such. This is a sign of malnutrition which does not occur without a reason. Unless there is an adequate explanation, this change should not be present in children or an elderly person without disease.
Hypopigmented areas — These are either signs of skin disease (loss of pigmentation in dark-skinned individuals) or old trauma, such as burns.
Raised lesions — Cancer, or more often, benign nodules.
Dark and flat skin lesions — Kaposi's sarcoma (cancer) in AIDS, melanoma (cancer), or benign moles.
Bleeding in the skin and tissues — Bruising from trauma (alcoholics, and older people bleed easily. The elderly commonly have bleeding under the skin (ecchymoses) on the forearms. Minor trauma will cause these. Other bruises may be caused by intentional or accidental abuse.
Spider angiomata — Small areas of dilated blood vessels seen most often in alcoholics.
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