“Livor Mortis?

Livor mortis refers to the presentation of blood as it has settled in the body. Depending on the presence and state of livor during the external exam, it may be useful for establishing two key elements of the investigation—postmortem interval and whether or not the body has been moved recently.

As soon as a person dies, blood essentially “reacts? to the pull of gravity and begins to collect in the lower parts of the body. Eventually the blood becomes stagnant and seeps into the areas of soft tissue that creates a purplish discoloration in the skin. This discoloration can appear as small blotches at first and can develop into larger areas in just a few hours. If a person is lying on their back in bed, then they should have posterior livor. If a person is lying face down on the floor, then they should have anterior livor. If a person is lying on their side, then they should have lateral livor.

I use the phrase “should have? in each example because of livor’s significance as to whether or not the body has been moved. Let’s say I work a scene where an elderly woman is found dead by her husband in the bedroom floor a few hours after going to take a nap. I can expect that any livor patterns present should be on whichever side of her body was against the floor. As soon as I enter the room, I attempt to evaluate livor with regard to position if at all possible. The individual may be clothed or there may not be any livor as it usually takes an hour or two before it is noticeable. My hope is that I recognize the body has been disturbed before I actually handle it to evaluate time of death. If it appears that any staging may have occurred, then there is a possibility of foul play. At the very least, evidence of the body being moved is cause for more questions before I proceed.

Let’s also say that the woman is face up on the floor and that her livor pattern is on the side of her body facing the ceiling. In most cases, the body has simply been rolled over and checked for vitals by paramedics. Questioning the officers present or the paramedics themselves addresses this issue. If first responders deny rolling the body over, then the husband has some explaining to do. Handling the body—or denying that he handled the body—doesn’t necessarily indicate foul play. Further questioning of the husband may reveal that he simply found his wife nude on the floor and wanted to clothe her before the ambulance arrived.

As long as the presentation of the livor is consistent with the position that the deceased was found in, then I proceed with the external examination. It is at this point that I can use livor to evaluate the approximate time of death by examining the areas of purplish discoloration. Depending on the manifestation of livor—small blotches versus larger areas—the person has likely been dead anywhere from 2-8 hours provided the livor has not become permanent or “fixed.? If the livor is fixed, then the person has likely been dead longer than 8 hours.

Determining fixation is not unlike determining the severity of a sunburn. Most people have pressed on an area of sunburned skin and noticed the color change that takes place when the finger is removed and the sunburn returns. Livor reacts the same way prior to becoming fixed. As long as the livor disappears momentarily or “blanches,? then it can be estimated that the death occurred between 2-8 hours prior. How quickly or how slowly the purplish discoloration returns will determine how close the livor is to becoming fixed. For the sake of “accuracy,? I like to evaluate more than one area and average the results as livor in different areas of the body can react differently.

Once the livor has become fixed, it will not shift with a change in body position. A person with fixed anterior livor will continue to have anterior livor even after being rolled onto their back. A person with anterior livor of just a few hours may have posterior livor by the time they spend the night on a morgue tray as their livor is still fluid and still affected by gravity.

There is another presentation of skin discoloration that should also be mentioned here, although it is much less common. Ingestion of certain substances can lead to an apparent livor pattern that is more red or cherry-pink than it is purple. This reddish discoloration may suggest ingestion of carbon monoxide, fluoride, or cyanide. The source of this discoloration has to do with how these substances affect the hemoglobin in the body. Many carbon monoxide or “CO? deaths where the person has committed suicide using vehicle exhaust fumes exhibit this kind of discoloration. Whereas the location of positional livor is affected by the orientation of the body, “toxic? livor can be seen in all surfaces of the skin regardless of body position.

Livor mortis should never be used as an exclusive means for establishing postmortem interval. In most cases, the onset of livor should be early enough that core temperature and the onset of rigor can be used to support the livor estimate.


2 Responses to “”

  1. 1 meagan
    June 23, 2005 at 9:06 am

    I absolutely love this site. I am looking to be a forensic scientist, and enjoy reading about related articles. When I found this site and read your articles, I was so amazed at the wonders that a coroner faces everyday. I would love to one day be in your position and be able to tell my own stories. I think the edge of humor that is coupled with the amazing facts makes your site an ultimate amazing find. Looking forward to future articles!!

  2. June 27, 2005 at 11:12 pm

    Kewl site! Thanks for sharing your real-live(er, rather … dead…) work!!

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