Livor mortis (hypostasis)
- Finding
Lividity is the red-purple discolouration of the lowest parts of a dead body, caused by blood settling under gravity.
What it is
Lividity (livor mortis, hypostasis) is the red-purple discolouration of the dependent parts of a dead body. Once circulation stops, blood drains by gravity into the vessels of the lowest areas. It may be seen in patches from about 20 minutes, is usually obvious by about 2 hours and well established between 2 and 6 hours. At first it blanches under pressure and shifts if the body is moved; over hours it becomes fixed, as blood leaves the vessels and stains the tissues, and no longer blanches. Areas pressed against a surface stay pale. Its site shows the position of the body, its colour may hint at the cause, and its degree of fixation gives a rough time clue.
How to tell it apart
- Lividity vs bruise: lividity lies in dependent areas, is not raised, and on incision shows no blood infiltrating the tissue; a bruise does.
- Lividity vs bruise under the microscope: in lividity red cells stay inside vessels; in a bruise they are outside.
- Internal hypostasis can mimic pneumonia in the lungs, posterior infarction in the heart or haemorrhage in the meninges.
- In advanced decomposition lividity and bruises may be impossible to tell apart.
How to recognise it
- Confluent red-purple patches in the lowest parts, with blurred borders, no swelling and no raised surface.
- Supine: back, buttocks and backs of the limbs, with pallor over the shoulder blades, buttocks and calves that bore weight.
- Suspended (hanging): legs, forearms and hands.
- Pinpoint haemorrhages within intense lividity (Tardieu spots), especially on the legs of suspended bodies.
How it forms
- Circulation stops and blood sinks by gravity within the vessels of the dependent areas.
- Over time, haemolysis and leakage of blood into the tissue stain the skin and the discolouration becomes fixed.
- Pressure from contact compresses the vessels and keeps blood from pooling (pressure pallor).
- It develops faster with heat and a good blood volume; it is less visible with severe anaemia, massive haemorrhage or dark skin.
Next step: what to do and document
- Describe the site, colour, extent and areas of pressure pallor, together with the position in which the body was found.
- Do the thumb-pressure test and record whether lividity blanches fully, partly or is fixed, with the time.
- If lividity does not match the body's position, write it down: it suggests movement and must be reported to the authority.
- With a cherry-red or pink colour, record it and request toxicology (for example carboxyhaemoglobin).
- With a doubtful mark, describe it without concluding and leave the distinction from a bruise to incision at autopsy.
Common mistakes
- Mistaking lividity for bruising and assuming violence.
- Reading pulmonary or myocardial hypostasis as pneumonia or infarction.
- Giving a time of death based on lividity alone.
- Always attributing cherry-red colour to carbon monoxide without considering cold or refrigeration.
Test yourself
Think of the answer, then tap the question to see it.
How is lividity told apart from a bruise when the skin is incised?
Lividity shows no blood infiltrating the tissues (the blood is inside vessels); a bruise shows haemorrhagic infiltration.
What does it mean when lividity blanches under finger pressure?
That it is not yet fixed; in general it suggests a few hours since death, with a very variable limit.
What causes cherry-red or pink lividity?
Carbon monoxide, cyanide, exposure to cold and refrigeration of the body.
Where is lividity found in a body that remained suspended?
In the lowest parts: legs and feet, and also forearms and hands.
Connections
Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Livor Mortis and Forensic Dermatology: A Review of Death-Related Gravity-Dependent Lividity and Postmortem Hypostasis (Cohen PR, Moss RJ, Prahlow JA) (Cureus, 2025); Development of a mobile application to estimate time of death based on the compound method (Zirn A et al.) (International Journal of Legal Medicine, 2026).
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Representative model, for educational purposes only.