Fatal systemic air embolism after blunt chest trauma: Postmortem computed-tomography findings

Air embolism as evidence of antemortem sexual activity

In the forensic autopsy examination of sexual assault cases, two essential questions must be addressed: whether sexual activity occurred, and whether sexual activity occurred antemortem or postmortem. However, confirming sexual activity can be challenging, particularly when the activity may not have involved penis-in-vagina intercourse and when semen detection results are negative. Moreover, determining whether the sexual activity took place antemortem or postmortem solely through forensic autopsy can be difficult. Here, we report a forensic autopsy case of sexual homicide with air embolism, suggesting antemortem sexual activity. Histopathological observations revealed that the origin of right ventricular air embolism was uterine vein exposure, allowing a significant amount of air to enter the endometrial cavity and eventually the bloodstream through venous exposure. Multiple squamous epithelial cells were identified in the endometrial cavity, indicating that an external force had pushed detached epithelial cells from the cervix or vagina into the uterine cavity. The present case highlights the importance of considering air embolism in suspected sexual assault cases.

Two cases of fatal iatrogenic air embolism confirmed by autopsies

The occurrence of air embolism is highly related to medical operations, and air embolism can cause sudden death. Such situations require attention in forensic work. This article reports two cases of iatrogenic air embolism confirmed by autopsy. In case 1, air embolism occurred after hydrogen peroxide was used to irrigate and disinfect a wound on the patient's left forearm. Approximately 90 ml of 3% hydrogen peroxide solution was used in case 1, and this volume can produce approximately 890 ml of oxygen by complete decomposition, which is far more than the average lethal air embolism volume. Attention should be given to the risk of air embolism when using hydrogen peroxide for irrigation and disinfection. In case 2, air embolism occurred during left ureteroscopy and stent placement. Due to inappropriate processing, the normal saline pump infused air into the patient at a high pressure of 120 mmHg. Based on our autopsy findings, we discuss the pathways of arterial air embolism and cerebral air embolism. In addition to the air entrainment volume and accumulation rate, the location of air accumulation also significantly impacts the risk of air embolism. After an arterial air embolus develops into a coronary and/or cerebral air embolus, the lethal air volume drops to only a few milliliters.