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Postmortem Lividity – Definition, Causes and Significance

Postmortem lividity refers to the bluish-red discoloration of the skin that develops after death as blood settles into the lowest areas of the body due to gravity.

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Things worth knowing about "Postmortem Lividity"

Postmortem lividity refers to the bluish-red discoloration of the skin that develops after death as blood settles into the lowest areas of the body due to gravity.

What Is Postmortem Lividity?

Postmortem lividity (also called livor mortis or livores mortis) refers to the bluish-red to violet discoloration of the skin that appears after death. It is one of the most reliable early signs of death and plays a crucial role in forensic medicine for estimating the time of death and determining the position of the body after death.

Causes and Development

After death, the heart stops beating and blood circulation ceases entirely. Without active pumping, blood is drawn downward by gravity and pools in the small blood vessels (capillaries and venules) closest to the skin surface. This pooled, oxygen-depleted blood (deoxyhaemoglobin) gives the skin a dark bluish-red appearance.

Discoloration appears in the lowest-lying areas of the body relative to its position.
Areas under pressure from contact with a surface (such as the back of a body lying supine) remain pale due to compression of the vessels.

Timeline and Phases

Livor mortis develops in distinct phases that are critical for forensic assessment:

Early Phase (approximately 1 to 6 hours after death)

Initial faint discoloration begins to appear. At this stage, the lividity is blanchable (it temporarily disappears when pressed) and relocatable: if the body is repositioned, the lividity shifts to the new lowest areas of the body.

Intermediate Phase (approximately 6 to 12 hours after death)

Discoloration deepens and becomes harder to blanch. Repositioning the body causes new lividity to form in the new dependent areas, while the original discoloration may still partially remain.

Late Phase (approximately 12 to 24 hours after death)

The lividity becomes fixed: it can no longer be blanched or relocated, as blood has either coagulated or diffused into the surrounding tissue. From this point onward, the pattern of lividity reliably reflects the original position of the body after death.

Distribution and Appearance

The location of livor mortis depends on the position of the body after death:

Supine position: back, buttocks, neck, calves
Prone position: abdomen, chest, face, forearms
Suspended position: lower limbs, hands

The typical color is dark bluish-red to violet. Variations in color may carry important diagnostic significance:

Cherry red: may indicate carbon monoxide poisoning or death in cold temperatures
Bright red: may suggest cyanide poisoning
Grayish-brown: may occur in methaemoglobinaemia

Forensic Significance

Postmortem lividity is a key finding during external examination of the body and forensic investigation. It provides information on:

Time of death: The developmental stage of lividity helps estimate the postmortem interval.
Body position after death: The distribution of discoloration indicates how the body was positioned following death.
Evidence of body relocation: If the pattern of lividity does not match the current position of the body, this may indicate that the body was moved after death.
Cause of death: Unusual coloration may suggest poisoning or other specific circumstances of death.

Differentiation from Other Skin Changes

Postmortem lividity must be distinguished from other types of skin discoloration:

Bruising (ecchymoses): Bruises result from trauma during life and are distributed independently of body position. Unlike lividity, the blood in bruises is located outside the blood vessels within the tissue.
Decomposition changes: In advanced stages of decomposition, greenish discoloration may occur and should not be confused with lividity.

References

Madea, B. (ed.) - Handbook of Forensic Medicine. Wiley-Blackwell, 2014.
Dettmeyer, R., Verhoff, M., Schuetz, H. - Forensic Medicine: Fundamentals and Perspectives. Springer, 2014.
DiMaio, V.J., DiMaio, D. - Forensic Pathology. CRC Press, 2nd edition, 2001.

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