The forensic pathologist hired by murder accused Jason Rohde agreed with the State on Wednesday that the injuries to Susan Rohde's neck "could well be the result of throttling and manual strangulation".
Prosecutor Louis van Niekerk had asked Dr Reggie Perumal if he was still comfortable with his finding on the cause of Susan's death at Spier Hotel in Stellenbosch on July 24, 2016.
Perumal did a second autopsy at Rohde's request more than a week after Susan's death and his report suggested her injuries were consistent with ligature strangulation.
Dr Asmal Coetzee-Khan, a state forensic pathologist who did the first autopsy, testified that Susan died as a result of lack of oxygen after manual strangulation and smothering.
Perumal told the court on Wednesday: "I said it is consistent with ligature strangulation. It definitely isn't the only cause of death I entertain... The findings in the neck could well be the result of throttling and manual strangulation. There are two competing causes. The injuries that we see could be seen in both scenarios."
He could not make a finding based only on the autopsy.
'Standard to say injuries consistent with most likely cause of death'
He explained that he favoured hanging as a more likely scenario because of the appearance of a ligature mark and Rohde's testimony that he saw a dribble of saliva from his wife's mouth, which suggested the ligature was applied while she was still alive.
Coetzee-Khan had found the left horn of Susan's thyroid cartilage was fractured and testified it indicated "a hand being applied to the neck with a squeezing type of action".
When shown photos of the cartilage and questioned, Perumal said that he was not completely disputing the presence of a fracture because it was the most common injury found in hanging cases.
But he said there was normally haemorrhaging with such a fracture.
Van Niekerk wanted to know why Perumal had not qualified his opinion in the autopsy report with everything he had just told the court.
Perumal replied that it was standard to say injuries were consistent with the most likely cause of death, not to mention all possible causes.
"I now put before the court that this [possible cause of death] must be considered."
Focus on bruise on wrist
Van Niekerk pointed out that Perumal's opinion played a major role in Rohde's bail hearing when the defence argued that there was no case against him and the charges should be dropped.
Perumal agreed with Van Niekerk that all these other factors he was "mulling over in his head" would have been important for the investigation team to take further.
On Wednesday, Perumal told the court that in his opinion he would have expected a deeper abrasion above Susan's left eye from falling over a low wall, as Rohde had testified she had done while they were arguing.
He said he could not exclude that this wound was caused by a ring on a fist but he would have expected to see lifted tissue.
Perumal said he felt all the injuries from the "fall" were blunt force injuries.
"I would say most if not all of the abrasions could be as a result of the incident described by the accused except possibly for a bruise on the wrist."
Had Susan fallen on a rough surface like a tarred road, it would more likely have resulted in an abrasion, not a bruise.
He told Van Niekerk it was possible that the bruise could have resulted from Susan being struck or restrained.
The trial continues.