Massive gas embolism revealed by two consecutive postmortem computed-tomography examinations

Makino, Yohsuke; Shimofusa, Ryota; Hayakawa, Motozo; Yajima, Daisuke; Inokuchi, Go; Motomura, Ayumi; Iwase, Hirotaro

doi:10.1016/j.forsciint.2013.06.001

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…CT can clearly depict the presence of air, even that present in small amounts; therefore, postmortem CT has recently become widespread as a routine forensic practice prior to autopsy . The findings in the present report suggest that decedents who suddenly die during treatment with olanzapine undergo not only biochemical testing but also CT scanning to elucidate the cause and mechanism of death.…”

Section: Discussionmentioning

confidence: 70%

Olanzapine‐Induced Fatal Ketoacidosis with Pneumomediastinum and Subcutaneous Emphysema

Torimitsu

Makino

Saka

et al. 2018

Journal of Forensic Sciences

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We report a case of fatal olanzapine‐induced ketoacidosis in which pneumomediastinum (PM) and subcutaneous emphysema (SE) were detected on postmortem computed tomographic (CT) images. A man in his forties was found in a state of cardiopulmonary arrest with profuse perspiration, and 50 empty capsules of olanzapine (10 mg) and flunitrazepam (1 mg) were found in his room. The major findings of postmortem CT prior to autopsy were PM and SE from the lower half of the face to the height of the first rib. The results of autopsy, biochemical tests, and toxicological analyses indicated the cause of death to be fatal ketoacidosis induced by olanzapine intoxication. No injuries, medical interventions, or particular diseases were evident, suggesting that PM and SE were caused by ketoacidosis. Our findings indicated that toxicological analyses should be performed when PM and SE are detected on CT images.

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Section: Discussionmentioning

confidence: 70%

Olanzapine‐Induced Fatal Ketoacidosis with Pneumomediastinum and Subcutaneous Emphysema

Torimitsu

Makino

Saka

et al. 2018

Journal of Forensic Sciences

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“…Advantages of pre-autopsy CT already include cause-ofdeath determination in some cases [1][2][3], trauma evaluation including gunshot wounds [4,5], evaluation of gas embolisms [6,7], and answering some anthropological questions [8,9]. Herein, we introduce cases to illustrate an additional important use of pre-autopsy PMCT.…”

Section: Introductionmentioning

confidence: 99%

Search and removal of radioactive seeds: another application of postmortem computed tomography prior to autopsy

et al. 2016

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We herein introduce 3 cases illustrating a new application for pre-autopsy postmortem computed tomography (PMCT). In all 3 cases, there was insufficient background information about the victims provided to the forensic pathologists' department. PMCT showed metallic particles in the prostate gland, an indication of metallic seeds containing radioactive isotopes. In 2 of 3 cases, migrated seeds were also detected by CT imaging in the lungs and the heart. Also in 2 of 3 cases, authorities reinvestigated the victim's history before autopsy was completed, which resulted in following appropriate procedure for dealing with the seeds. Although all 3 cadavers were cremated after autopsy, the International Commission on Radiological Protection (ICRP) discourages cremation for deaths soon after radioactive seeds implantation to prevent air pollution by radioactive isotopes in the ash. Our opinion from the present cases is that pre-autopsy PMCT can be recommended for use by forensic pathologists and guidelines for investigating deaths after permanent brachytherapy should include how to deal with cadavers when medical history is limited.

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“…There are also published cases of pre-mortem, post-traumatic ICG not associated with heady injury, such as ICG following stab wounds [14]. In medico-legal literature, ICG is only discussed in the context of the mechanism of death by gas embolism which is further accompanied by gas embolism in the cerebral vessels, such as cases of decompression in divers [21], administration of intravenous oxygen [22], or helium intoxication. [23].…”

Section: Discussionmentioning

confidence: 99%

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

Borowska-Solonynko

Koczyk

Blacha

et al. 2019

Forensic Sci Med Pathol

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The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0-48 days) and 0.01 day (0-1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.

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Massive gas embolism revealed by two consecutive postmortem computed-tomography examinations

Cited by 14 publications

References 40 publications

Olanzapine‐Induced Fatal Ketoacidosis with Pneumomediastinum and Subcutaneous Emphysema

Olanzapine‐Induced Fatal Ketoacidosis with Pneumomediastinum and Subcutaneous Emphysema

Search and removal of radioactive seeds: another application of postmortem computed tomography prior to autopsy

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions

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