Massive intramuscular hemorrhage of the tongue caused by hanging

Intramuscular hemorrhage of the tongue is frequently observed when the neck is compressed. Airway obstruction caused by massive hemorrhagic tongue edema has been reported. Herein, we report an autopsy case of massive intramuscular hemorrhage of the tongue caused by suicide via hanging. A 90-year-old woman was found dead in her living room in the right lateral position with a fabric band around her neck. Unenhanced computed tomography revealed massive intramuscular hemorrhage of the tongue. A ligature mark was observed around the neck. An autopsy revealed prominent swelling of the tongue caused by massive intramuscular hemorrhage. Bilateral ossification of the stylohyoid ligament was observed, and both lungs showed distension. We suspected that the woman fell after attempting suicide via hanging. In this case, the possibility that the lung distension was caused by the swollen tongue could not be ruled out. The direct pressure on the base of the tongue caused by the hyoid bone and the combination of pressure on the base of the tongue and jugular vein caused by ossification of the stylohyoid ligament likely caused the massive intramuscular hemorrhage of the tongue. This mechanism should be considered in survivors of hanging attempts.