Selective Postmortem Marbling in the Upper Body: A Case of Cardiac Tamponade.

We present a forensic case of a man in his late 50s who lost consciousness while driving, resulting in a lowspeed (approximately 10 km/h) collision with a wall. He was found unresponsive at the scene and transported to a hospital. Despite resuscitative efforts, he was pronounced dead. A judicial autopsy was conducted 5.5 days postmortem after refrigerated storage. Externally, postmortem marbling was distinctly observed in the head, neck, and upper limbs, whereas the trunk and lower extremities remained unaffected. Internally, approximately 300 mL of hemopericardium was found due to a tear in the anterior wall of the left ventricle. Histological examination revealed acute coronary artery occlusion with intraplaque hemorrhage, indicating an ischemic origin of the myocardial rupture. This case illustrates a rare and regionally selective manifestation of decomposition, with marbling limited to the upper body. We hypothesize that venous congestion caused by cardiac tamponade created a localized microenvironment favorable to bacterial proliferation, facilitating selective marbling. Although refrigeration delays decomposition, it does not prevent it. Our findings demonstrate that antemortem circulatory conditions may influence the regional distribution of early postmortem changes, which should be considered in forensic interpretation.