Guards found him in his cell at the Metropolitan Correctional Centre in Manhattan early on Saturday morning US time. He could not be revived. Attorney General William Barr, whose department oversees the Bureau of Prisons facility where Epstein died, has described his death as an "apparent suicide". Justice officials declined to comment on the new information from Epstein's autopsy. Loading Replay Replay video Play video Play video The office of New York City's chief medical examiner, Barbara Sampson, completed an autopsy of Epstein's body on Sunday. But Sampson listed the cause of his death as pending. Sampson's office did not comment on the injuries found in the autopsy.

Loading The details add to the bizarre circumstances surrounding Epstein's death, which have launched a wave of questions and conspiracy theories about how he could have died in federal custody. Even US President Donald Trump has egged on speculation, without evidence, that Epstein - whose alleged victims say they were pushed to have sex with his powerful and celebrity friends - might have been killed to keep him from spilling the secrets of others. The revelation of Epstein's neck injuries follows reports that officers at the Metropolitan Correctional Centre broke protocol and failed to monitor him properly. Corrections officers had not checked on Epstein for "several" hours before he was found in his cell, a person familiar with the matter said, one of a series of missteps in the hours leading up to his death.

Loading Veteran prosecutors and law enforcement officials were shocked that one of the most high-profile inmates in the country wasn't more carefully watched. Barr said over the weekend he was "appalled" at serious "irregularities" in jail protocol, and later transferred the jail warden to another facility. People familiar with the autopsy, who spoke on the condition of anonymity due to the sensitive stage of the investigation, said Sampson's office is seeking additional information on Epstein's condition in the hours before his death. That could include video evidence of the jail hallways, which may establish whether anyone entered Epstein's cell during the night he died; results of a toxicology screening to determine if there was any unusual substance in his body; and interviews with guards and inmates who were near his cell.

Loading Jonathan Arden, president of the National Association of Medical Examiners, said a hyoid can be broken in many circumstances, but is more commonly associated with homicidal strangulation than suicidal hanging. Arden, who was not involved in the Epstein autopsy, said that, in general, a finding of a broken hyoid requires pathologists to conduct more extensive investigation. That investigation can include analysis of the location of the noose, how narrow the noose is, and if the body experienced any substantial drop in the course of the hanging. The age of the deceased is also important, Arden said. The hyoid starts out as three small bones with joint-like connections but hardens during middle age into a U-shape that can break more easily. "If, hypothetically, the hyoid bone is broken, that would generally raise questions about strangulation, but it is not definitive and does not exclude suicidal hanging," he said.

Loading A handful of studies conducted over the past decade have produced conflicting results about the likelihood of a hyoid break in a suicide. In a study of 20 suicidal hangings in Thailand, published in 2010, one-quarter of the men who hanged themselves had broken hyoids. In a larger study of suicidal hangings of young-adults and middle-aged people in India, conducted from 2010 to 2013, hyoid damage was found in just 16 of 264 cases, or 6 per cent. The study addressed the discrepancies in academic reviews, saying wide variations in findings of hyoid breaks are "possibly due to factors like age of the victim, weight of the victim, type of suspension and height of suspension". Hyoid fractures have previously sparked controversy in jailhouse and other contentious deaths. In 2008, Ronnie White, a teenager accused of killing a police officer, died of an apparent suicide in a suburban Washington jail cell. But, two days later, the cause of death was changed to homicide when a Maryland state medical examiner discovered the teen had a broken hyoid.

Loading The incident fanned racial tension and fuelled conspiracy theories about the suspect's death in Prince George's County, Maryland. Medical examiners concluded White was probably strangled with a sheet, towel or "crux of the elbow". The officer who moved his body pleaded guilty to obstruction. But no one was ever charged in White's death. A federal judge said in 2013 that it remained a mystery whether the inmate was slain or took his own life. The hyoid bone played a central role in a heated dispute last year over another high-profile death in New York, that of Eric Garner. A New York police officer was accused of using an improper chokehold while trying to arrest Garner and of causing his death. A police officers' union claimed that an autopsy from Sampson's office found there was no break of Garner's hyoid bone, and that this proved that the officer could not have strangled Garner and caused his death.

Loading This "demonstrates conclusively that Mr Garner did not die of strangulation of the neck from a chokehold", the Patrolmen's Benevolent Association said. But Sampson rejected that claim, saying she stood by her conclusion that Garner died of "compression of neck (chokehold), compression of chest and prone positioning during physical restraint by police". Sampson's office said Garner's bronchial asthma, obesity and high blood pressure were contributing factors. In a widely circulated video of the 2014 incident, the officer was seen grabbing Garner around the neck, pushing him and his face into the pavement. Garner is overheard pleading several times: "I can't breathe." Two weeks later, Sampson's office concluded the officer's actions were the primary cause of his death.