Autopsy Report: 56-year-old Iraqi Male, Al Qaim, Iraq (Homicide) (Death Certificate Included)

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

AUTOPSY EXAMINATION REPORT Autopsy No.: ME03-571
~~~r(_6K~__~=-______~ AFIP No.: 2901039
Rank:~-----J
Date ofBirth: 1947 Place of Death: Al Qaim, Iraq Date/Time of Death: 26 Nov 2003 Place of Autopsy: BIAP Mortuary, Date/Time of Autopsy: 2 Dec 2003
Baghdad, Iraq Date of Report: 18 Dec 2003
Circumstances of Death: This Iraq~b)(BK Idied while in U.S. custody. The details surrounding the circumstances at the time of death are classified.
Authorization for Autopsy: AnnedForces Medical Examiner, per 10 U.S. Code 1471
Identification: Visual by 3rd Armored Cavalry Regiment, postmortem fingerprint and DNA obtained
CAUSE OF DEATH: Asphyxia due to smothering and chest compression
MANNER OF DEATH: Homicide
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AUTOPSY REPORT ME03-571
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FINAL AUTOPSY DIAGNOSES:
I. History of smothering and chest and abdominal compression
II.
Blunt force trauma

A. Contusions and abrasions of the skin and soft tissue ofthe chest and abdomen with patterned contusions
1. Fractures of left ribs 3-7
B. Extensive contusions and abrasions of the extremities with patterned contusions

C.
Minor contusion of the scalp TIl. Cardiomyopathy (650 grams)

A. Left ventricle hypertrophy (1.7cm)
1. Myocyte hypertrophy and interstitial and perivascular fibrosis
B. Mild atherosclerosis of the aorta
C. Pulmonary edema (combined weight == 1350 grams)

N.
Status post cholecystectomy

A. Perihepatic and pericolonic adhesions

v.
Hepatic steatosis (fatty change), microscopic

VI. Hepatitis B positive (DNA)
VII. Pleural and pubnonary adhesions
VIII. Perisplenic adhesions
IX.
Nodular prostate

x.
Early decomposition

XI. No displaced fractures or radiopaque projectiles on radiographs Xll. Toxicology negative
E ~
EXTERNAL EXAMINATION
The body is that ofa well-developed, well-nourished appearing, obese, 71 1/2 inch tall, 250 pounds minimum (estimated) male whose appearance is consistent with the reported age of 56 years. Lividity is posterior and purple. There is facial suffusion and congestion ofthe conjunctival vessels but no petechiae ofthe eyes, face, or oral mucosa. Rigor is not apparent. There is early decomposition consisting ofvascular marbling ofthe anterior chest.
The scalp is covered with gray-brown hair measuring 1Y4 inch in length and in a nonna) distribution. There is a brown beard and mustache. The irides are brown and slightly obscured by corneal clouding. The ears and external auditory canals are unremarkable. The nares are patent and the lips are atraumatic. The nose and maxillae are palpably stable. The teeth appear natural and adequate in repair. There are no injuries ofthe oral cavity.
The neck is straight, and the trachea is midline and mobile. The chest is symmetric. The abdomen is protuberant. The genitalia are those of a nonna} adult male. The testes are descended and free ofmasses. Pubic hair is present in a nonnal distribution. The buttocks and anus are developmentally unremarkable.
The upper and lower extremities are symmetric and without clubbing or edema. Flexicuff wrist ties encircle each wrist but there are no associated abrasions or contusions.
Identifying marks and scars include an oblique 8 x v., inch scar and 2 adjacent oblique scars measuring % x Y2 inch each on the right upper quadrant of the abdomen (cholecystectomy). On the skin ofthe right patella is a 1 ~inch linear scar and on the skin ofthe left patella is a 1 Y4 inch linear scar. On the posterior right shoulder and ann are a 4 x 2 inch scar, a 1 Y2 x I Yz inch scar, a 2 % inch linear scar, a 3 Y2 inch linear scar, and a 1 x ~inch scar.
Encircling the right wrist is a white plastic identification band with" 3 ACR 76".
CLOTHING AND PERSONAL EFFECTS The following clothing items and personal effects accompany the body at the time of autopsy:
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Long black shirt

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White undershirt

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Tan boxer style underpants

MEDICAL INTERVENTION

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Intravenous puncture marks in the right groin and right antecubital fossa

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A 1 ~x 7/8 inch dried orange abrasion overlying the sternum (CPR artifact)

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RADIOGRAPHS A complete set ofpostmortem radiographs is obtained and demonstrates the following:
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No displaced fractures

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No radiopaque foreign objects (bullets or shrapnel)

EVIDENCE OF INJURY The ordering ofthe following injuries is for descriptive purposes only, and is not intended to imply order ofinfliction or relative severity. All wound pathways are given relative to standard anatomic position.
DESCRIPTION OF BLUNT FORCE INJURIES:
Head and Neck:
On the right parieto-occipital scalp is a 1 'is. x 1 v.. inch purple contusion without fracture
ofthe underlying skull. There is a Y2 x Y4 inch area ofdiscoloration ofthe superior belly
ofthe right omohyoid muscle without injury ofthe remaining anterior strap muscles.
Dissection ofthe posterior neck and spinal cord is free of injury.

Chest and Abdomen:
On the anterior right side ofthe chest superior to the nipple is a 5 x I ~inch crescentic
purple contusion and on the left side ofthe anterior chest is a 2 Y4 X 1 v.. inch purple
contusion. On the midline ofthe anterior abdominal wall are a 5 x 3 Y2 inch purple
contusion, a triangular 5 Y2 X 2 inch purple contusion, and a triangular 6 Y2 x 2 inch purple
contusion. On the left lower quadrant ofthe abdomen is a 4 x 3 Y4 inch purple contusion.
Adjacent to and admixed with the above contusions are numerous circular to ovoid red­
purple contusions ranging from Y4 to Yz inch. On the midline ofthe upper back is a 3 % x
2 inch pwple contusion. On the left costovertebral angle is a 7 Y2 x 3 inch purple
contusion. On the postero-Iateralleft rib cage is a faint 6 x 3 Y2 inch purple contusion. On
the right costovertebral angle and lower back are a 4 Y2 x 2 inch purple contusion and a 7
~x 1 Yz inch purple contusion.

~Jn?es within the ~hest incl~de n~n-displaced fractures ofthe a~terior.aspe~t of the 5th_
7 nbs on the left SIde and 3 _6th nbs on the postero-Iateralleft SIde. DIssectIon ofthe
parietal pleura from the rib cage reveals hemorrhage surrounding these fractures. There
are no injuries ofthe lungs or remaining organs ofthe chest and abdominal cavities.
Dissection ofthe skin of the back reveals scattered Y4 -Y2 inch purple contusions ofthe
soft tissue.
Pelvis and Buttocks:
On the right buttock and extending onto the anteri or right hip is an irregularly shaped 13
Yz x 8 inch dark purple contusion with hemorrhage of the underlying subcutaneous tissue
but without contusion or fracture ofthe underlying musculoskeletal system. Adjacent to
this contusion is a patterned contusion consisting of two parallel oblique purple
contusions measuring 3 Y4 x 1 inch and 4 x 1 Y4 inch with a Y2 inch area ofclearing
between these contusions. On the left buttock and extending onto the posterior thigh are
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an irregularly shaped 7 Y2 x 4 %inch purple contusion and two oblique parallel purple contusions measuring 5 Y2 inches and 612 inches.
Lower Extremities: On the anterior right thigh is an oblique 9 x 6 inch red-purple contusion. On the mid anterior right thigh are two parallel purple contusions occupying an area 6 x 3 inches with a 3/8-112 inch are ofcentral clearing. Adjacent to these contusions are mUltiple pinpoint red abrasions. On the skin overlying the right patella is a 2 Yz x I YI inch purple contusion. On the right anterior shin is a 4 x 3 inch purple contusion. On the skin overlying the right lateral malleolus is a 5 ~ x 2 Y4 inch purple contusion and on the skin overlying the right medial malleolus is an 8 Y4 x 4 inch purple contusion. On the plantar surface ofthe right foot is a 2 x I Y.t inch purple contusion. In the right popliteal fossa is a 4 x 4 VI inch purple contusion.
On the left inguinal area is a 1 !II x 2 Y4 inch purple contusion. On the anterior left thigh are 2 purple contusions measuring 4 Y4 x 3 VI inches and ~x 12 inch, respectively. On the anterior and lateral left thigh is a patterned contusion consisting ofthree parallel oblique purple contusions occupying an area 6 x 4 inches with Yz inch areas ofclearing between contusions. On the skin overlying the left patella and anterior shin is a patterned contusion consisting oftwo parallel, horizontal purple contusions occupying an area 6 x 4 inches with Yz inch area ofclearing between contusions. On the anterior left shin is a patterned contusion occupying an area 6 x 4 ~inches and consisting ofan irregularly shaped contusion within which are two parallel purple contusions with a 3116 inch area of clearing. On the medial left shin is a ~inch purple contusion. On the skin overlying the left medial malleolus is a 3 x 2 inch purple contusion. On the posterior left thigh is a 5 x 5 Y2 inch purple contusion. On the left calfis an oblique lOx 2 ~inch purple contusion with a Y2 inch area ofcentral clearing.
Upper Extremities: On the anterior and posterior left ann, elbow, and forearm is a 13 YI X9 Y4 inch area of diffuse purple contusion without an apparent pattern. There is no injury ofthe underlying bones. On the anterior left shoulder is a 2 ~x 1 y,. inch purple contusion. On the anterior right shoulder is a 3 Y2 x % inch purple contusion. On the posterior right ann is a 2 Y2 x 2 inch purple contusion. On the posterior right elbow is a lOx 9 inch purple contusion without injury ofthe underlying bones. There is no significant injury ofeither hand or
wrist.
INTERNAL EXAMINATION
HEAD: The galeal and subgaleal soft tissues of the scalp have the noted minor contusion. The calvarium is intact, as is the dura mater beneath it. Clear cerebrospinal fluid surrounds
·····1 the 1250 gm brain, which has unremarkable gyri and sulci. Coronal sections demonstrate sharp demarcation between white and grey matter, without hemorrhage or contusive
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AUTOPSY REPORT ME03-S71
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IDJUry. The ventricles are ofnonnal size. The basal ganglia, brainstem, cerebellum, and
arterial systems are free of injury or other abnonnalities. There are no skull fracture~).
The atlanto-occipital joint is stable.

NECK:
The anterior strap muscles ofthe neck are homogenous and red-brown, without
hemorrhage. There is a focal area ofdiscoloration ofthe superior belly ofthe right
omohyoid muscle. The thyroid cartilage and hyoid are intact. The larynx is lined by
intact white mucosa. The thyroid is symmetric and red-brown, without cystic or nodular
change. The tongue is free ofbite marks, hemorrhage, or other injuries.

Incision and dissection ofthe posterior neck demonstrates no deep paracervical muscular
injury and no cervical spine fractures or ligament injury. Sections of the cervical spinal
cord are unremarkable.

BODY CAVITIES:
There are the noted rib fractures. No excess fluid is in the pleural, pericardial, or
peritoneal cavities. The organs occupy their usual anatomic positions with surgical
absence ofthe gallbladder and perihepatic adhesions. There are bilateral fibrous pleural,
perisplenic, and pericolonic adhesions.
RESPIRATORY SYSTEM:
The right and left lungs weigh 650 and 700 gm, respectively. The external surfaces are
deep red-purple and have the noted adhesions. The pulmonary parenchyma is diffusely
congested and edematous. No mass lesions or areas of consolidation are present.
CARDIOVASCULAR SYSTEM:
The 650 gm heart is contained in an intact pericardial sac. The epicardial surface is
smooth, with extensive fat investment. The coronary arteries are present in a normal
distribution, with a right-dominant pattern. Cross sections ofthe vessels show no
significant atherosclerosis. The myocardium is homogenous, red-brown, and finn. The
valve leaflets are thin and mobile. The walls ofthe left and right ventricles are 1.7 and
O.6-cm thick, respectively. The endocardium is smooth and glistening. The aorta gives
rise to three intact and patent arch vessels. The renal and mesenteric vessels are
unremarkable.
LIVER & BILIARY SYSTEM:
The 1900 gm liver has an intact capsule and a sharp anterior border. The parenchyma is
tan-brown and congested, with the usual lobular architecture. No mass lesions or other
abnormalities are seen. The gallbladder is surgically absent.

SPLEEN:
The 275 gm spleen has the noted perisplenic adhesions. The parenchyma is maroon and
congested, with distinct Malpighian corpuscles.

PANCREAS:
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The:pan.cteas is finn and yeUow ..,tan,with the-usuallobulararchitectlJre, NQ mass ~esions
or other abnonnalitiesare.seen.

ADRENALS:
The right and left adrenal glands are symmetric but autolysed. No masses or areas of
hemorrhage are identified.

GENITOURINARY. SYSTEM:
The rightand left kidneys weigh 180 grp. each. The external surfaces are intact and
smooth. The cut surfaces are rep-tan and cOngested, witb. uniformly thick cortices and
sharp corticomedullary junctions. The pelves are unremarkable and the ureters are
normal incourse and caliber. Whitehlad4er I;llucosa overlies an intact bladder wall. The
bladder is empty. The prostate is normal ,in size, with lobular, yellow-tan parenchyma and
nodular. The seminal vesicles are unremarkable. The testes are free ofmass lesions,
contusions, or other abnonnalities.

GASTROINTESTINAL TRACT:
The esophagus is intact and lined bYSI.llootl;l, grey-white rnucosa. The stomach 'contains
approximately 30, ml ,ofbroWll liqui4. -.rAe ga!)tric :wall is intact. The duodenllm, loops of
small bow~l, and colon are,unrem~kable. The appendix is present and unremarkable.

,ADDITIONAL PROCEDURES
• Documentary photographs are taken by TSGT /b)(8}-2
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_SpeciaLAgentr~8}-1 lof Army Criminal Investigative Division (CID) attendedthe autopsy

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Specimens retained for toxicologic testing and/or DNA identification are: blood, spleen, liver, l\lDg" kidney, brain, gastric, and psoas

•
The dissected organs are forwarded with 'body

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Personal effects are released to the appropriate mortuary operations
representatives

MICROSCOPIC EXAMINATION Heart: Sections show mild -moderate myocyte hypertrophy, perivasCUlar and interstitial fibrOSis, and fatty infiltration of the right ventricle, Postmortem overgrowth ofbacteria without an inflammatory response is noted.
Lungs: Sections show intra-alveolar edema fluid, perivasuclar anthracosis, congestion,
and postmortem overgrowth ofbacteria without an inflammatory response~ No
polarizable foreign material is identified.
Kidney: Section shows vascular congestion and autolysis. No polarizable foreigI! material
is identified.
Liver: Secti(ms show moderate predominantly macrovesicular steatosis, mild periportal fibrosis, and no significant inflammation.
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Brain: Section shows no ~ignificantpathologic abnormality.
Right omohyoid muscle: Section shows no significant pathologic abnonnality.
Contusion ofthe right ,buttock: Sections shows extravasation oferythrocytes withouta significant inflammatory response and no significant hemosiderin deposition by H and E stain.
SEROLOGY Postmortem serologic testing for antibodies to human .immunodeficiency virus (HIV) and hepatitis Cvirus were non-reactive (negative).
Spleenwas positive for hepatitisB DNAby:PCR. .
TOXICOLOGY Toxicologic analysis ofblood and liver was negative for carbon monoxide, cyanide, ethanol (alcohol), ,and illicit substances (drug~).
. OPINION This 56 year-old Iraqi detainee died ofasphyxia due to smothering and chest compression. Significant findings ofthe autopsy included rib fractures and numerous contusions (bruises), some ofwhich werep,atterned:due to impacts with a blunt object(s). Another fInding ofthe autopsy was an ema.rgedhemt. the etiology ofwhich is Ullcertajn. Other findingsincluded,a fatty liver, which can be seen most commonly with obesity or alcohol abuse, The,~plee~ w~positiv,e for hepatitis Il DNA by polY111erase;chain reaction (peR). th~re were·scarsinthec4est cavitympstlikely due to an old infection. Scars were noted illt~e,abd()minal cavity dueto pJjor surgical removal of the gallbladder.
Although ~er:tlarged heart may result in sudden death, the history surrounding the death
along with patterned contusions and broken ribs support a traumatic cause ofdeath and
therefore the manner ofdeath is best classified as homicide.

MAJ,MC, USA
Deputy Medical Examiner,

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FORM REPLACES DA FORM 3565, I JAN 72 AND DA FO~356S-R(PAS)' 16 SEP 75. WHICH ARE PBSOLETE. l~PR~ ...
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