Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: Multi-slice computed tomography diagnosis

Otal, Philippe; Loubes-Lacroix, F.; Rousseau, Hervé; Costagliola, R.; Telmon, Norbert; Joffre, F.; Rougé, Daniel

doi:10.1016/j.forsciint.2005.07.012

Cited by 8 publications

(2 citation statements)

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“…4 MDCT has been employed to investigate gas distribution after scuba diving fatalities. 5 Reliable distribution patterns have been proposed and should confirm the results of the autopsy. 6 In parallel, other studies have developed the Radiological Alteration Index (RAI) based on the volume and distribution of postmortem gases in the body to estimate its decomposition state.…”

Section: Introductionmentioning

confidence: 84%

Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas

et al. 2017

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Introduction: Important developments in the diagnosis of scuba diving fatalities have been made thanks to forensic imaging tool improvements. Multi-detector computed tomography (MDCT) permits reliable interpretation of the overall gaseous distribution in the cadaver. However, due to post-mortem delay, the radiological interpretation is often doubtful because the distinction between gas related to the dive and post-mortem decomposition artifactual gases becomes less obvious. Methods: We present six cases of fatal scuba diving showing gas in the heart and other vasculature. Carbon dioxide (CO 2) in cardiac gas measured by gas chromatography coupled to thermal conductivity detection were employed to distinguish decomposition from embolism based on the detection of decomposition gases (hydrogen, hydrogen sulfide and methane) and to confirm arterial gas embolism (AGE) or post-mortem offgasing diagnoses. A Radiological Alteration Index (RAI) was calculated from the scan. Results: Based on the dive history, the intra-cadaveric gas was diagnosed as deriving from decomposition (one case, minimal RAI of 61), post-mortem decompression artifacts (two cases, intermediate RAI between 60 and 85) and barotrauma/AGE (three cases, maximal RAI between 85 and 100), illustrating a large distribution inside the bodies. Conclusion: MDCT scans should be interpreted simultaneously with compositional analysis of intra-cadaveric gases. Intracadaveric gas sampling and analysis may become useful tools for understanding and diagnosing scuba diving fatalities. In cases with short post-mortem delays, the CO 2 concentration of the cardiac gas provides relevant information about the circumstances and cause of death when this parameter is interpreted in combination with the diving profile.

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Section: Introductionmentioning

confidence: 84%

Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas

et al. 2017

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“…Even a small amount of gas entering the arterial system can occlude end arteries, with as little as 0.5-1 mL of air injected into the pulmonary vein causing cardiac arrest as a result of coronary air embolism and resultant ischaemia. 2,8,14 Administration of 0.02 mL/kg of gas into the coronary arteries in a dog model was associated with a mortality rate of 28%, and it has been estimated that for an embolus to pass through capillaries of 6 mm diameter a blood pressure of 200 mmHg is required. 6 In the reported case there was no injury to major vessels or significant blood loss, with the victim appearing initially stable.…”

Section: Discussionmentioning

confidence: 99%

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

Temlett

Byard

2011

Med Sci Law

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A 29-year-old man was shot in the chest twice sustaining extensive contusion of the right lung. He was, however, clinically stable with no major vessel injury or significant blood loss. Unexpected cardiac arrest occurred hours after hospital admission due to left coronary artery air embolism. Lung parenchymal damage from the passage of two projectiles within the chest wall close to the pleural cavity had occurred, with disruption of the capillary-alveolar interface and passage of air into the pulmonary venous circulation. While tangential gunshot wounds to the chest wall may rarely cause air embolism, symptoms are usually immediate. The present case demonstrates, however, that death may occur unexpectedly some time after the initial trauma in an individual who is considered clinically stable.

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Medico-Legal Aspects of Pulmonary Thromboembolism

Margiotta¹,

Coletti²,

Severini³

et al. 2016

Advances in Experimental Medicine and Biology

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Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: Multi-slice computed tomography diagnosis

Cited by 8 publications

References 20 publications

Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas

Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

Medico-Legal Aspects of Pulmonary Thromboembolism

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