Modern Diagnostic Features of Forensic Medical Examination in Mechanical Asphyxia

Abstract

Mechanical asphyxia is a type of death caused by obstruction of the airways or suffocation resulting from external mechanical force. This article examines the modern diagnostic features of forensic medical examination in cases of mechanical asphyxia. The study was conducted based on scientific publications published between 2022 and 2025 and analyzes the pathological, histological, and biochemical changes observed in deaths caused by hanging, strangulation, ligature strangulation, and compression. Modern diagnostic methods, including virtual autopsy (PMCT and PMMRI), proteomics, miRNA analysis, and three-dimensional photogrammetry, are discussed with particular emphasis on their clinical significance and their complementary role to conventional autopsy. The findings indicate that neck compression accounts for approximately 55% of mechanical asphyxia-related deaths; however, the absence of petechial hemorrhages in 38% of victims complicates the diagnostic process. Proteomic analysis identified 78 differentially expressed proteins specific to mechanical asphyxia. Virtual autopsy demonstrated a diagnostic sensitivity of 90–100% in traumatic deaths, whereas its sensitivity in asphyxial deaths remained below 30%. Based on the obtained findings, the article proposes a unified algorithmic approach for forensic medical experts.