Relevance of postmortem radiology to the diagnosis of fatal cerebral gas embolism from compressed air diving

Cole, Alisa; Griffiths, D; Lavender, S; Summers, Paul; Rich, Keith M.

doi:10.1136/jcp.2005.031708

Cited by 27 publications

(20 citation statements)

References 7 publications

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“…In a second study, sheep were euthanatized after a period of simulated diving in a pressurized air; the cadavers were then examined by sequential postmortem CT at surface Vet Pathol 46:3, 2009 pressure. 7 All the sheep developed significant quantities of gas in the vascular system within 24 hours, as demonstrated by CT and necropsy, while the control animals did not. Those authors concluded that the presence of gas in the vascular system of human cadavers after diving-associated fatalities was to be expected and is not necessarily connected with gas embolism after pulmonary barotrauma, as had previously been claimed.…”

Section: Discussionmentioning

confidence: 99%

“…In a controlled experiment using a sheep as a model, it was reported that small gas pockets could be imaged on CT within 24 hours postmortem with no dysbaric exposure. 7 The amount of gas, however, was minimal and would likely be overlooked in dissection. The failure of case No.…”

Section: Discussionmentioning

confidence: 99%

“…The lipid content of a tissue may have a great effect, because nitrogen is .5 times more soluble in lipid than in water at 1 absolute atmosphere and 37uC. 3,7 Factors that influence bubble nucleation are less clearly understood. Although sound impacts have been hypothesized to have the potential to cause bubble nucleation in humans and marine mammals, 10 less is known about the mechanisms inhibiting bubble formation.…”

Section: Discussionmentioning

confidence: 99%

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Gas Bubbles in Seals, Dolphins, and Porpoises Entangled and Drowned at Depth in Gillnets

et al. 2009

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Abstract. Gas bubbles were found in 15 of 23 gillnet-drowned bycaught harp (Pagophilus groenlandicus), harbor (Phoca vitulina) and gray (Halichoerus grypus) seals, common (Delphinus delphis) and white-sided (Lagenorhyncus acutus) dolphins, and harbor porpoises (Phocaena phocaena) but in only 1 of 41 stranded marine mammals. Cases with minimal scavenging and bloating were chilled as practical and necropsied within 24 to 72 hours of collection. Bubbles were commonly visible grossly and histologically in bycaught cases. Affected tissues included lung, liver, heart, brain, skeletal muscle, gonad, lymph nodes, blood, intestine, pancreas, spleen, and eye. Computed tomography performed on 4 animals also identified gas bubbles in various tissues. Mean 6 SD net lead line depths (m) were 92 6 44 and ascent rates (ms 21 ) 0.3 6 0.2 for affected animals and 76 6 33 and 0.2 6 0.1, respectively, for unaffected animals. The relatively good carcass condition of these cases, comparable to 2 stranded cases that showed no gas formation on computed tomography (even after 3 days of refrigeration in one case), along with the histologic absence of bacteria and autolytic changes, indicate that peri-or postmortem phase change of supersaturated blood and tissues is most likely. Studies have suggested that under some circumstances, diving mammals are routinely supersaturated and that these mammals presumably manage gas exchange and decompression anatomically and behaviorally. This study provides a unique illustration of such supersaturated tissues. We suggest that greater attention be paid to the radiology and pathology of bycatch mortality as a possible model to better understand gas bubble disease in marine mammals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gas Bubbles in Seals, Dolphins, and Porpoises Entangled and Drowned at Depth in Gillnets

et al. 2009

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“…21.41) as well as the lung, sinus and ear changes associated with barotrauma. These techniques are more accurate than plain radiography or conventional autopsy techniques and provide detailed information on the extent and distribution of gas in tissues that is inaccessible by standard autopsy or in tissues from which bubbles may vanish during autopsy procedures (Plattner et al 2003;Cole et al 2006). MRI can also detect DCS-associated spinal cord changes (Gempp et al 2008).…”

Section: Radiology Computed Tomography and Magnetic Resonance Imagingmentioning

confidence: 99%

Injuries due to Asphyxiation and Drowning

Keil¹,

Lunetta²,

Vann³

et al. 2014

Handbook of Forensic Medicine

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“…3). This is a well-recognized phenomenon in clinical radiological practice whereby gas is introduced along the line of needle tracks and has been demonstrated on CT in an experimental sheep model [7]. There were also 1 or 2 small bubbles of IHG and no ICG ( Fig.…”

Section: External Examinationmentioning

confidence: 94%

Progressive gas formation in a deceased person during mortuary storage demonstrated on computed tomography

Singh

O’Donnell

Woodford

2009

Forensic Sci Med Pathol

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We report the case of an 82-year-old woman with a past history of diabetes mellitus who died following blunt head injury sustained in a fall resulting in an acute subdural hematoma. Serial postmortem CT scans of the chest and abdomen performed over a 3-day period demonstrated progressive intra-hepatic and intra-cardiac gas formation whilst the deceased was stored in a standard mortuary refrigerator at a nominated temperature of 4 degrees C. Measured mortuary refrigerator temperatures over a 7 day period showed statistically significant day to day variability in temperatures above 4 degrees C as well as variations in temperature depending on location within the refrigerator space. In the absence of other known factors associated with such gas formation, putrefaction seems the likely cause despite a lack of obvious external features. This phenomenon must therefore be taken into account when interpreting the presence of visceral gas on postmortem CT and relating such gas to the cause of death.

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Relevance of postmortem radiology to the diagnosis of fatal cerebral gas embolism from compressed air diving

Cited by 27 publications

References 7 publications

Gas Bubbles in Seals, Dolphins, and Porpoises Entangled and Drowned at Depth in Gillnets

Gas Bubbles in Seals, Dolphins, and Porpoises Entangled and Drowned at Depth in Gillnets

Injuries due to Asphyxiation and Drowning

Progressive gas formation in a deceased person during mortuary storage demonstrated on computed tomography

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