In response to a recent case report published in the International Journal of Legal Medicine entitled "A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign?", we wish to corroborate the findings of periadventitial hemorrhages at the junctions of the posterior intercostal arteries in cases of suicidal hanging and to reveal two other novel aortic lesions associated with hanging. In our ongoing prospective study, we identified six cases of aortic intimal ruptures among 257 suicidal hanging deaths, along with the novel observation of subintimal hemorrhages-both of which have not been previously documented in the forensic literature. Our findings suggest that the complex anatomy of the aorta and surrounding structures may increase the vulnerability of vascular structures during hanging, particularly under conditions of complete suspension. We propose that reported aortic lesions may serve as significant morphological indicators of hanging, thereby enriching its medicolegal investigation. To establish the diagnostic relevance of these findings, further prospective autopsy studies with larger sample sizes are warranted.

Department of Forensic Medicine Faculty of Medicine in Hradec Králové Charles University Sokolská 581 Šimkova 870 Hradec Králové 500 03 Czech Republic

Department of Forensic Medicine University Hospital Hradec Králové Sokolská 581 Hradec Králové 500 05 Czech Republic

Institute of Legal Medicine and Medico legal Expertise Jessenius Faculty of Medicine Comenius University Martin Slovak Republic

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Lange-Herr N, Tschui J, Klaus J, Baglivo M, Schlottke E, Zech WD (2024) A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign? Int J Legal Med. https://doi.org/10.1007/s00414-024-03261-9 PubMed DOI PMC

Hejna P (2011) Amussat’s sign in hanging–A prospective autopsy study. J Forensic Sci 56:132–135. https://doi.org/10.1111/j.1556-4029.2010.01548.x PubMed DOI

Saternus KS (1984) Injury of the vertebral artery in suicidal hanging. Forensic Sci Int 25:265–275. https://doi.org/10.1016/0379-0738(84)90076-8

Asirdizer M, Kartal E (2022) Neck vascular lesions in hanging cases: a literature review. J Forensic Leg Med 85:102284. https://doi.org/10.1016/j.jflm.2021.102284 PubMed DOI

Sauvageau A, Ambrosi C, Kelly S (2012) Autoerotic nonlethal filmed hangings: a case series and comments on the estimation of the time to irreversibility in hanging. Am J Forensic Med Pathol 33:159–162. https://doi.org/10.1097/PAF.0b013e3181ea1aa6 PubMed DOI

Hejna P, Rejtarová O (2010) Bleedings into the anterior aspect of the intervertebral disks in the lumbar region of the spine as a diagnostic sign of hanging. J Forensic Sci 55:428–431. https://doi.org/10.1111/j.1556-4029.2009.01312.x PubMed DOI

Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P (2018) Laryngohyoid fractures in suicidal hanging: a prospective autopsy study with an updated review and critical appraisal. Forensic Sci Int 290:70–84. https://doi.org/10.1016/j.forsciint.2018.05.043 PubMed DOI

Suarez-Penaranda JM, Alvarez T, Miguens X et al (2008) Characterization of lesions in hanging deaths. J Forensic Sci 53:720–723. https://doi.org/10.1111/j.1556-4029.2008.00700.x PubMed DOI

Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic D (2003) Analysis of neck injuries in hanging. Am J Forensic Med Pathol 24:179–182. https://doi.org/10.1097/01.PAF.0681069550.31660.f5 PubMed DOI