Autopsy Report: 35 Year-Old Afghani Male, Bagram Collection Point, Afghanistan (Homicide) (Death Certificate Included)

Autopsy No: A02-95. 35-year-old Afghan male civilian detainee was found unresponsive and retained in his cell and was pronounced dead upon arrival at the 339th CSH, Bagram Air Field. Cause of Death: Blunt force injuries to lower extremities complicating coronary artery disease. Manner of death: homicide.

Doc_type: 
Medical
Doc_date: 
Tuesday, February 25, 2003
Doc_rel_date: 
Sunday, April 17, 2005
Doc_text: 

ARMED FORCES INSTITUTE OF PATHOLOGY
Office of the Armed Fortes Medical Examiner
1413 Research Blvd., Bldg. 102
Rockville, MD 20850
1-800-944-7912

Landstuhl Regional Medical Center
Landstuhl, Gennany, APO AE 09180
DSN 486-7492
CIV 011 (49) 6371-86-7492

AUTOPSY EXAMINATION REPORT
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Autopsy No.: A02-95 (Landstuhl
Nam~:
I
R.M.C. Autopsy Number) SSANL-__________~ AFIP No.: 2859183
Date ofBirth: Unknown, age approx. 35 yrs. Rank: Civilian, Afghani national DatelTime ofDeath: 10 Dec 2002/0200z Place ofDeath: Bagram Collection
Point, Bagram Air Field, Afghanistan DatelTime ofAutopsy: 13 Dec 2002/1000 Place ofAutopsy: Bagram Air Field Date ofReport: 25 Feb 2003 Afghanistan
Circumstances of Death: Approximately 35 year old Afghan male detainee who was
found unresponsive restrained in his cell in the Bagram Collection Point, and pronounced
dead on arrival at the 339th CSH, Bagram Air Field, Afghanistan.
Authorization for Autopsy: The Armed Forces Medical Examiner, lAW 10 USC 1471.
Identification: Visual; Post mortem dental examination performed; Fingerprints and DNA specimen obtained.
CAUSE OF DEATH: Blunt force injuries to lower extremities complicating coronary artery disease
MANNER OF DEATH: Homicide
FINAL AUTOPSY DIAGNOSES:
I. Blunt force injuries to bilateral lower extremities with rhabdomyolysis
a. Extensive soft tissue hemorrhage with muscle necrosis
i. Involving bilateral legs, extending from upper thighs to upper calves and bilateral inguinal regions
11. Nearly circumferential muscle damage, from subcutis to level of , periosteum of femurs
.j
iii. Histologically, extensive muscle destruction with necrosis
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AUTOPSY REPORT A02-95
b. c. d. Rhabdomyolysis i. Urine and serum positive for myoglobin ii. Brown discoloration ofurine Hemorrhage ofbilateral knee joint capsules Diffuse erythema and contusions of skin ofposterior and lateral thighs and upper calves, and bilateral inguinal regions
ll. Coronary artery disease a. Atherosclerotic plaque ofproximal left anterior descending coronary artery with 70-80% luminal occlusion; 50% mid LAD luminal occlusion b. Histologically, myocardial sections show no significant histopathologic changes (Cardiovascular pathology consultation)
Ill. Multiple superficial abrasions, contusions, and crusts ofbilateral wrists, anterior ankles, nose, and ears
IV. Toxicology, Anned Forces Institute of Pathology a. Heart blood and vitreous fluid negative for ethanol b. Urine negative for drugs of abuse

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AUTOPSY REPORT A02-9S
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EXTERNAL EXAMINATION

The body is that ofa thin, nonnally developed, unclad Afghan male. The body is 69" in height, appears consistent with a weight of 122 pounds as reported in the medical record, and appears compatible with the reported age of35 years. The body is cold. Rigor is present to an equal degree in all extremities. Lividity is present and fixed on the posterior surface ofthe body, except in areas exposed to pressure. The skin is moderately pigmented. The head is normocephalic. The scalp hair is dark and shaved close, 2mm in length. Facial hair consists ofa dark brown beard and mustache. The irides are brown. The corneae are clear. The conjunctivae are pale and dry. The sclerae are white and free of petechia. The external auditory canals, external nares and oral cavity are free of foreign material and abnormal secretions. The nasal skeleton is palpably intact. The lips are without evident injury, and both the upper and lower frenulum are intact. There are approximately 8 small petechia on the upper gingiva. The teeth are natural and in good condition. The chest is unremarkable. The abdomen is flat and soft. On the back ofthe head in the occipital scalp, there is a well-healed 2 cm curvilinear scar. There is a well­healed circular 1 cm diameter scar on the lateral upper right arm, and there is a 3 em linear scar on the palmer base ofthe right thumb. On the back ofthe left elbow, there is a 1 cm diameter scar. Across the upper back, there are mUltiple punctate scars. The extremities show normal development and range ofmotion. The fingernails are short and intact. The external genitalia are those ofa normal adult uncircumcised male with both testes descended. The posterior torso is without note.
EVIDENCE OF THERAPY
There is a nasogastric tube and an endotracheal tube secured with white tape, both appropriately placed. There are four EKG tabs on the upper right chest, upper left chest, mid chest, and lower left abdomen. Over the sternum, there is a 5 x 3 cm contusion, consistent with resuscitation efforts.
EVIDENCE OF INJURY
HEAD AND NECK: On the upper right forehead, there are two linear abrasions, 0.3 and
0.5 em in length. On the upper left forehead, there is a 0.5 x 0.2 em abrasion. Down the bridge ofthe nose, there is a vertically oriented 2 x 1.3 em abrasion with crust formation. On the back ofhead in the upper central occipital scalp, there are three crusted abrasions,
0.3 em, 0.2 cm, and 0.2 em in diameter. Behind the pinna ofthe left ear, there are multiple curvilinear abrasions with crust formation and focal contusion, fonning two vertically oriented parallel lines, 1.5 x 0.3 cm laterally and 1.0 x 0.2 cm medially. Behind the pinna ofthe right ear, there are two crusted abrasions, 0.5 x 0.2 cm and 0.3 x 0.2 cm. On the right anterior aspect ofthe neck, there is a faint, irregular contusion with focal excoriation and fine linear crust formation, 4 x 5 em in aggregate dimension. On the left anterior neck, there is a 0.5 x 0.3 em abrasion.
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AUTOPSY REPORT A02-95 [bX6~ I
CHEST: Upon reflection ofthe skin ofthe right lateral chest, there is a 15 x 7 cm area of hemorrhage within the superficial aspect ofthe intercostal muscles at the level ofthe 5­
6th
ribs. On dissection, there is no deep muscular hemorrhage, and there are no rib
fractures or any evidence of any intrathoracic trauma.

ABDOMEN and BACK: On the lower right abdomen, there is a 0.4 x 0.2 cm abrasion
with crust formation. On the lateral upper left buttock, there is a 6 x 0.2 em linear
abrasion with crust formation.

UPPER EXTREMITIES: On the back ofthe right elbow on the medial aspect, there is a 2 x 1.5 em brown contusion. Around the ventral (palmar) and lateral (radial) right wrist, there is a 12 x 2 cm band oferythema and red-brown contusion, which is the widest at the lateral aspect. Within the lateral aspect of the contusion, there is focal superficial abrasion, up to 0.3 cm in diameter. On the back ofthe hand, there is a 0.3 cm diameter crusted abrasion.
On the back ofthe left elbow, there is a lateral 2 x 2 cm brown contusion and a medial 0.6 x 0.5 cm crust. Around the ventral and lateral left wrist, there is a 8 x 2 em band of erythema and red-brown contusion. The contusion is widest at the lateral aspect, and there is a 0.3 cm diameter abrasion within the ventral lateral region. On the back of the left hand, beneath the index finger, there is a 0.5 x 0.3 cm crusted abrasion.
LOWER EXTREMITIES: There is bilateral contusion of inguinal regions. In the right inguinal region, there is a 30 x 7 em region of erythema and red-brown contusion, extending from the lower abdomen down the medial thigh. In the left inguinal region there is a 30 x 15 em region oferythema and red-brown contusion, extending from the lower abdomen down the anterior and medial thigh. Upon reflection ofthe skin, there is underlying diffuse, superficial and deep intramuscular hemorrhage bilaterally. There is no apparent contusion ofthe scrotum, and no evidence of testicular hemorrhage.
Over the lateral and posterior right leg, extending from the upper thigh down to just below the knee, there is a ill defined band oferythema and red-brown contusion. On the posterior aspect ofthe knee, the discoloration is the darkest, forming a more discrete brown-purple contusion. On the anterior right ankle, there is a 1.3 x 1 em crusted abrasion.
Over the lateral and posterior left leg, extending from the upper thigh down to just below the knee, there is a similar ill defined band oferythema and red-brown contusion, which is most pronounced on the posterior knee. On the lateral left knee, there is also a 3 x 5 em abrasion. Beneath the left knee, there is a 7 x 2 cm red-brown contusion. On the anterior left ankle, there is a 1.5 x 1 cm crusted abrasion. On the top ofthe right foot, at the base ofthe first toe, there is a 0.5 x 0.2 cm crusted abrasion.
Upon reflection ofthe skin ofthe legs, there is bilateral diffuse hemorrhage from the subcutis, through all ofthe muscle layers, extending to the periosteum. On the right, the hemorrhage extends over the entire posterior and lateral aspect ofthe leg from the upper thigh, just beneath the buttock, to the mid calf. On the left, the hemorrhage is nearly circumferential, with only slight sparing ofthe medial thigh, and extends from the upper thigh,just beneath the buttock, to the mid calf. Bilaterally, there is extensive muscle breakdown and grossly visible necrosis with focal crumbling ofthe tissue. There
DOD 003159

AUTOPSY REPORT A02-95
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is bilateral intracapsular hemorrhage of the knee joints, but both knees are palpably
stable.

INTERNAL EXAMINATION
BODY CAVITIES:
The body is opened by the usual thoraco-abdominal incision and the chest plate is removed. No adhesions or abnormal collections of fluid are present in any ofthe body cavities. All body organs are present in the normal anatomical position. The subcutaneous fat layer of
the abdominal wall is 1/4" thick. There is no internal evidence ofpenetrating injury to the
thoraco-abdominal region.

HEAD: (CENTRAL NERVOUS SYSTEM)
The scalp is reflected. The calvarium ofthe skull is removed. The dura mater and falx
cerebri are intact. There is no epidural, subdural or subarachnoid hemorrhage present. The
leptomeninges are thin and delicate. The cerebral hemispheres are symmetrical, and the gyri
demonstrate the usual orientation and configuration. The structures at the base ofthe brain,
including cranial nerves and blood vessels, are intact. Coronal sections through the cerebral
hemispheres revealed no lesions. The ventricles are normal. Transverse sections through the
brain stem and cerebellum are unremarkable. The brain is ofnormal size, and there is no
evidence ofany brain swelling or herniation. The posterior fossa is unremarkable. The upper
portion ofthe spinal cord viewed tlrrough the foramen Magnum is unremarkable.

NECK:
Examination ofthe soft tissues ofthe neck, including strap muscles, thyroid gland and large
vessels, reveals no abnormalities. The hyoid bone and larynx are intact. A posterior neck
dissection reveals no evidence ofhemorrhage or trauma.

CARDIOVASCULAR SYSTEM:
The pericardial surfaces are smooth, glistening and unremarkable; the pericardial sac is free
ofsignificant fluid and adhesions. The heart appears to be ofnormal size and weight. The
coronary arteries arise normally and follow the usual distribution. There is an atherosclerotic
plaque within the proximal left anterior descending coronary artery, with approximately 70­80% occlusion and focal 50% occlusion ofthe mid LAD, but with no evidence ofthrombus
formation. The other coronary arteries are widely patent, without evidence ofsignificant
atherosclerosis or thrombosis. The chambers and valves exhibit the usual size-position
relationship and are unremarkable. The myocardium is dark red-brown, firm and
unremarkable; the atrial and ventricular septa are intact. The aorta and its major branches
arise normally, follow the usual course, are widely patent with scattered fatty intimal
streaks, and are free ofany other abnormality. The venae cavae and their major tributaries
return to the heart in the usual distribution and are free ofthrombi. The left ventricle is 1.3
cm in thickness, and the right ventricle is 0.4 cm in thickness. (See Cardiovascular
Pathology report)

RESPIRATORY SYSTEM:

DOD 003160

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I
The upper airway is clear ofdebris and foreign material; the mucosal surfaces are smooth,
yellow-tan and unremarkable. The pleural surfaces are smooth, glistening and
unremarkable bilaterally. The pulmonary parenchyma is red-purple, exuding slight amounts
ofbloody fluid; no focal lesions are noted. The pulmonary arteries are normally developed,
patent and without thrombus or embolus.

LIVER & BILIARY SYSTEM:
The hepatic capsule is smooth, glistening and intact, covering dark red-brown, moderately
congested parenchyma with no focal lesions noted. The liver is ofnormal size. The
gallbladder contains 3 mi. ofgreen-brown, mucoid bile; the mucosa is velvety and
unremarkable. The extrahepatic biliary tree is patent, without evidence ofcalculi.

ALIMENTARY TRACT:
The tongue exhibits no evidence ofrecent injury. The esophagus is lined by gray-white,
smooth mucosa. The gastric mucosa is arranged in the usual rugal folds and the lumen is
essentially empty, containing only a film ofdark fluid. The small and large bowel are
unremarkable. The pancreas has a normal pink-tan lobulated appearance and the ducts are
clear. The appendix is Jresent and unremarkable.

GENITOURINARY SYSTEM:
The renal capsules are smooth and thin, semi-transparent and strip with ease from the
underlying smooth, red-brown cortical surfaces. The kidneys are of normal size. The
cortices are sharply delineated from the medullary pyramids, which are red-purple to tan and
unremarkable. The calyces, pelves and ureters are unremarkable. The urinary bladder is
distended, containing approximately 200 ml ofdark brown urine. The bladder mucosa is
gray-tan and unremarkable. The prostate is small and unremarkable, and the testes are free
ofhemorrhage or masses.

RETICULOENDOTHELIAL SYSTEM:
The spleen has a smooth, intact capsule covering red-purple, moderately firm parenchyma;
the lymphoid follicles are unremarkable. The spleen is ofnormal size. The regional lymph
nodes appear normal. There is minimal residual thymus present.

ENDOCRINE SYSTEM:
The pituitary, thyroid and adrenal glands are unremarkable.

MUSCULOSKELETAL SYSTEM:
See "Evidence ofInjury". Otherwise, no bone or joint abnormalities are noted, and muscle
development is normal.

MICROSCOPIC EXAMINATION
SKELETAL MUSCLE. LOWER EXTREMETIES: Multiple sections of skeletal muscle show extensive interstitial hemorrhage, widespread disruption ofthe myocytes, and focal areas of confluent muscle necrosis, with minimal inflammatory response.
DOD 003161
HEART: Sections of the myocardium reveal intact striated muscle fibers. There is no
evidence ofatrophy, hypertrophy, and recent or old myocardial infarction. (See
Cardiovascular Pathology consult)

LUNGS: The alveolar spaces and small air passages are expanded and contain no significant inflammatory component or edema fluid. The alveolar walls are thin and not congested. The arterial and venous vascular systems are normal. The peribronchial lymphatics are unremarkable.
LIVER: The hepatic architecture is intact. The portal areas show no increased
inflammatory component or fibrous tissue. The hepatic parenchymal cells are well
preserved with no evidence ofcholestasis, fatty metamorphosis, or sinusoidal
abnormalities.

SPLEEN: The capsule and white pulp are unremarkable. There is minimal congestion of the red pulp.
ADRENALS: The cortical zones are distinctive and well supplied with lipoid. The
medullae are not remarkable.
KIDNEYS: The subcapsular zones are unremarkable. The glomeruli are mildly congested without cellular proliferation, mesangial prominence, or sclerosis. The tubules are unremarkable. There is no interstitial fibrosis or significant inflammation. There is no thickening ofthe walls ofthe arterioles or small arterial channels.
BRAIN: Multiple sections ofbrain demonstrate an unremarkable configuration of gray and white matter, which is appropriate for age. There is no evidence ofatrophy, inflammation, hemorrhage, or neoplasm.
OTHER PROCEDURES:
1.
Blood, urine, vitreous, and tissue samples were submitted for toxicologic examination.

2.
Tissue was retained for possible histological examination and DNA identification.

3.
Documentary photographs and dental radiographs were taken.

4.
The dissected organs were returned to the body.

5.
Portions ofheart and histological sections ofmyocardium submitted to
Cardiovascular Pathology, AFIP, report below:

AFIP Cardiovascular Pathology Consultation, Dql6~2
L--___---'
" Heart: Heart weight unknown (received in fragments); closed foramen ovale; normal valves; normal atrial and ventricular cavity dimensions; left ventricular free wall thickness
DOD 003162
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AUTOPSY REPORT A02-95
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1.3 cm; interventricular septum thickness 1.2 cm; right ventricle thickness 0.4 cm; grossly Wlfemarkable myocardium; myocardial sections demonstrate no significant histopathologic changes.
Coronary arteries: Nonnal ostia; right dominant circulation; focal moderate-to-severe atherosclerosis; remaining gross artenes demonstrate 35% lumen area narrowing of the left main and 25% lumen area narrowing of the proximal left anterior descending; submitted histologic sections demonstrate 70% lumen area narrowing of the proximal left anterior descending. "
OPINION: This approximately 35-year-old Mghan male detainee died ofblunt force injuries to the lower extremities, complicating underlying coronary artery disease. The blunt force injuries to the legs resulted in extensive muscle damage, muscle necrosis, and rhabomyolysis. Electrolyte disturbances, primarily hyperkalemia (elevated blood potassium level) and metabolic acidosis can occur within hours ofmuscle damage. Massive sodium and water shifts occur, resulting in hypovolemic shock and vasodilatation, and later, acute renal failure. The decedent's underlying coronary artery disease would compromise his ability to tolerate the electrolyte and fluid abnormalities, and his underlying malnutrition and likely dehydration would further exacerbate the effects ofthe muscle damage. The manner ofdeath is homicide.
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MAJ, USAF, Me, FS LTC,MC, USA
Assistant Medical Examiner Regional Medical Examiner

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MEDICAL STATEMENT Ded.ratlan medieale

DO FORM 2064. APR 1977 REPLACES DA FORM 3665, , JAN 1972 AND DA FORM 3565-RIPASI, 26 SEP 1975, WHICH ARE OBSOLETE, USAPA Vl,OO
MEDCOM -169 :285916J
DOD 003296

Doc_nid: 
3280
Doc_type_num: 
72