Although not strictly an injury, the documentation of the presence or absence of pin-point petechial haemorrhages (or petechiae) can prove to be of central forensic importance.

Petechiae may develop after alleged airway obstruction or from the application of forceful neck pressure (strangulation). These need to be documented and photographed at the earliest opportunity as they will disappear quickly. If a patient is seen in circumstances where an asphyxial component of an assault is reported, it is important to examine the face, especially around the eyes and eyelids, after makeup has been removed.

Petechiae can best be seen inside the eye lids, and in the mouth. It is important to specifically look for petechiae or else these may easily be missed. Other injuries relevant to the alleged assault, such as finger nail abrasions and fingertip bruising around the external airway and on the neck must also be carefully looked for.

Figure 13. Petechial haemorrhages.