The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT.

Schulze, Katja; Ebert, Lars Christian; Ruder, Thomas; Fliss, Barbara; Poschmann, Sebastian Alexander; Gascho, Dominic; Thali, Michael Josef; Flach, Patricia Mildred (2018). The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT. The British journal of radiology, 91(1084), p. 20170479. British Institute of Radiology 10.1259/bjr.20170479

[img] Text
29327945.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy


The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma.


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.


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 (>40 years, 88.9%) and less common in younger subjects (<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%.


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. Advances in knowledge: (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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Schulze, Katja and Ruder, Thomas


600 Technology > 610 Medicine & health




British Institute of Radiology




Nicole Rösch

Date Deposited:

19 Jul 2018 13:06

Last Modified:

05 Dec 2019 04:20

Publisher DOI:


PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback