Elsevier

Legal Medicine

Volume 27, July 2017, Pages 1-4
Legal Medicine

Case Report
Postmortem computed tomography evaluation of fatal gas embolism due to connection of an intravenous cannula to an oxygen supply

https://doi.org/10.1016/j.legalmed.2017.05.004Get rights and content

Highlights

  • We investigated a case of accidental gas embolism at a hospital.

  • Postmortem CT demonstrated accumulations of gas in the heart and vessels.

  • The gas distribution suggested the route that the infused gas would have taken.

  • Postmortem CT was useful for detailed examination of gas embolism.

Abstract

An 84-year-old man who had suffered from chronic obstructive pulmonary disease accompanied by moderate pneumonia as well as gastric cancer with liver metastasis was found dead by a nurse, who noticed that the patient’s intravenous catheter in the left forearm had been erroneously connected to an oxygen supply in his hospital room, leading to infusion of oxygen into a vein. Postmortem CT scanning demonstrated multiple accumulations of gas in the pulmonary artery, the right atrium and ventricle, as well as the left subclavian and brachiocephalic veins, corresponding to the route that the infused gas would have taken to the heart and pulmonary artery. Conventional autopsy revealed the presence of gas in the right ventricle. These findings suggested that the immediate cause of death was a gas embolus due to oxygen that had entered the cardiopulmonary circulation via the intravenous catheter. This case highlights the usefulness of postmortem imaging as an aid to conventional autopsy for demonstrating gas embolism.

Introduction

Postmortem computed tomography (PMCT) is becoming common in the practice of forensic medicine [1], [2]. Imaging methods have revolutionized not only forensic diagnosis but also the documentation of evidence that can be applicable in court proceedings [3]. In addition, PMCT is a superior tool for finding air within the body, such as pneumothorax and gas embolism of the heart and great vessels [4], [5]. Traditional invasive autopsy may miss a cardiac gas embolus unless the conventional autopsy techniques are employed. However, traditional techniques can be supplemented with PMCT [6], [7], [8]. Here we report an unusual case of gas embolism, in which an intravenous catheter was accidentally misconnected to the oxygen supply. In the present case, PMCT demonstrated cardiac gas embolism accompanied by the presence of gas within the left subclavian and brachiocephalic veins, which seemed to be consistent with the route of gas ingress from an intravenous catheter in the left forearm, whereas subsequent autopsy was able to locate the presence of gas in the right ventricle. PMCT prior to autopsy appears to provide a useful guide to forensic pathologists when conducting careful examinations for gas embolism.

Section snippets

Case history

An 84-year-old man who had suffered from chronic obstructive pulmonary disease (COPD) accompanied by moderate pneumonia and gastric cancer with liver metastasis was hospitalized because of fever, dyspnea and disorientation that had appeared on the previous day. He had been receiving oxygen therapy at home and chemotherapy as an outpatient. Physical examination indicated wheezing, and pulse oximetry demonstrated a subcutaneous oxygen saturation of 70%. After admission, he was supplied with

Radiological findings

Just before autopsy, which was undertaken two days after the deceased had been found, the entire body of the deceased was examined by CT scan at the Autopsy Imaging Facility, Gunma University Graduate School of Medicine. All scans were performed using a four-slice CT scanner (Asteion/TSX-021B/4A, Toshiba, Japan) with a slice thickness of 1 mm and settings of 120 kV and 225 mAs for the head and 120 kV and 100 mAs for the body. 3D transparent volume-rendered images were reconstructed on a CT

Autopsy findings

At autopsy, the body was 158 cm in height and 64.7 kg in weight. External examination revealed a puncture surrounded by bruising on the left forearm. Livor mortis was prominent in the back, while we did not obtain any information regarding a change of body position after death declaration. And rigor mortis persisted. There was no evidence of advanced postmortem change such as gaseous or putrefactive fluid-fluid skin blisters on any part of the body. In addition, there were no external signs of

Discussion

A cardiac gas embolus may be overlooked by conventional postmortem examination unless relevant information is available prior to forensic autopsy and a targeted research approach is implemented from the beginning. In general, the main method for diagnosis of gas embolism is radiographic inspection. Therefore, invasive autopsy techniques have been supplemented by PMCT. However, air within the vasculature is one of several artifacts that can be visualized by PMCT, and air in the heart is a

References (19)

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