Examination of the trunk, in addition to noting lesions of the skin, should be directed toward detecting regions of pain, tenderness or discomfort that would reflect underlying injuries of the musculature, ribs or abdominal organs. The examiner must consider the possibility of intramuscular, retroperitoneal and intra-abdominal hematomas, as well as laceration or rupture of an internal organ. Ultrasonography, CT scans and bone scintigraphy should be used, when realistically available, to confirm such injuries. Routine examination of the cardiovascular system, lungs and abdomen should be performed in the usual manner. Pre-existing respiratory disorders are likely to be aggravated in custody, and new ones may develop. Near asphyxiation often leaves no marks and may cause acute and chronic respiratory problems as well as other complications.
Victims can be exposed in a confined space to smoke or tear gas. Many survivors will give an account of a persistent dry cough for a few days or weeks afterwards, probably as a result of inhalation pneumonitis (inflammation of the lungs). Some survivors say that they have been asthmatic since such an incident, but it would be very difficult to demonstrate causation. Examination of the lungs, and respiratory function tests are usually normal.
Rib fractures are a frequent consequence of beatings to the chest. If displaced, they may be associated with lacerations of the lung and possible pneumothorax. Fractures of the vertebral pedicles may result from direct blunt force. Fractures of the lower right ribs carry approximately a 10% risk of hepatic injury.
Following acute abdominal trauma, the physical examination must seek evidence of damage to abdominal organs or the urinary tract, but this examination is often negative. Gross haematuria is the most significant indication of kidney contusion. Organ injury may present on investigation as free air, extraluminal fluid, and areas of low attenuation, which may represent oedema, contusion, haemorrhage or a laceration. Peripancreatic edema is one of the signs of acute traumatic and non-traumatic pancreatitis. Ultrasound is particularly useful in detecting subcapsular hematomas of the spleen. Peritoneal lavage may detect occult abdominal haemorrhage, but free abdominal fluid detected subsequently on CT scan might be from the lavage or haemorrhage; thus invalidating the finding. Acute renal failure due to crush syndrome may be seen acutely following severe beatings.
