{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:22:11Z","timestamp":1784895731101,"version":"3.55.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1084","license":[{"start":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T00:00:00Z","timestamp":1517443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective:<\/jats:title>\n                  <jats:p>The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, \u201cthe gas bubble sign\u201d, in cases of hanging as a diagnostic indicator of neck trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (&amp;gt;40 years, 88.9%) and less common in younger subjects (&amp;lt;40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p>The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge:<\/jats:title>\n                  <jats:p>(1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1259\/bjr.20170479","type":"journal-article","created":{"date-parts":[[2018,1,12]],"date-time":"2018-01-12T14:16:46Z","timestamp":1515766606000},"source":"Crossref","is-referenced-by-count":41,"title":["The gas bubble sign\u2014a reliable indicator of laryngeal fractures in hanging on post-mortem CT"],"prefix":"10.1093","volume":"91","author":[{"given":"Katja","family":"Schulze","sequence":"first","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Christian","family":"Ebert","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Daniel","family":"Ruder","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"},{"name":"Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern , Bern , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Fliss","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian Alexander","family":"Poschmann","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Gascho","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Josef","family":"Thali","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Mildred","family":"Flach","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland"},{"name":"Clinic for Radiology and Nuclear Medicine, Kantonal Hospital St. Gallen , St. Gallen , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,2,1]]},"reference":[{"key":"2024050214264113500_b1","unstructured":"Centers for disease control and prevention\n.\nSurveillance for violent deaths\u2014national violent death reporting system, 16 states\n.\n2009\n. 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