Massive Pulmonary Embolization by Cerebral Tissue After Head Trauma in an Adult Male

Abstract

We report a case of an adult man who was run over by a car, suffering severe head trauma. After 3 hours in the hospital, he experienced sudden and severe hemodynamic deterioration, dying immediately. The autopsy showed massive cerebral tissue pulmonary embolization (CTPE), confirmed by immunohistochemistry. Multiple fractures of the skull, tear of the transverse sinus, and brain laceration of the occipital lobe were present. CTPE is very infrequent. In children and adults, it occurs as a complication of severe closed or penetrating head trauma. Although laceration of a large cerebral venous sinus is not always essential, in some cases (like in the present one) this laceration is the mechanism of entry of the cerebral tissue to the blood circulation. The clinical repercussion of CTPE is variable. In some cases, it could be an incidental finding of autopsy. In other cases, coagulation abnormalities and disseminated intravascular coagulation have been reported. Finally, such as in the present case, the immediate cause of death is the sudden hemodynamic failure due to the massive CTPE.

Cerebral Tissue Pulmonary Embolism in Elderlies

“…Based on previous case reports and summarized reviews, we found 39 reported cases of CTPE after severe head trauma. [2][3][4][5][6][7][8][9][10][11][12][13][14] For instant deaths in these cases, the victims were 47 years or younger (Table 1), whereas in our case, the victim was 65 years old (the eldest case of CTPE with instant death). The younger ages in these reported cases may relate to better cardiac health.…”