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Böckers A, Steinhoff S, Scholl T, Kunz SN. [Suicidal gas embolism in hospital]. Rechtsmedizin (Berl) 2021; 32:271-276. [PMID: 34539087 PMCID: PMC8438279 DOI: 10.1007/s00194-021-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Luftembolien sind im klinischen Alltag nach traumatischen oder iatrogenen Ereignissen eine häufig zu beobachtende Entität. Fälle einer in suizidaler Absicht herbeigeführten Luftembolie sind selten. Die Konnektivität von luft- und flüssigkeitsführenden Schlauchsystemen ermöglicht die Zufuhr großer Gasmengen in kurzer Zeit mit häufig tödlichem Ausgang. Der Einsatz einer Computertomographie vor der Obduktion ist in solchen Fällen obligat und ermöglicht eine umfassende Darstellung der zugeführten Gasmengen. Wir präsentieren den ungewöhnlichen Fall einer suizidalen venösen Gaszufuhr mittels eines stationären Sauerstoffgerätes in einem Krankenhaus.
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Affiliation(s)
- A Böckers
- Institut für Rechtsmedizin, Universitätsklinikum Ulm, Prittwitzstr. 6, 89075 Ulm, Deutschland.,Universität Ulm, Ulm, Deutschland
| | - S Steinhoff
- Radiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - T Scholl
- Pathologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian N Kunz
- Institut für Rechtsmedizin, Universitätsklinikum Ulm, Prittwitzstr. 6, 89075 Ulm, Deutschland.,Universität Ulm, Ulm, Deutschland
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2
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Worasuwannarak W, Peonim V, Srisont S, Udnoon J, Chudoung U, Kaewlai R. Comparison of postmortem CT and conventional autopsy in five trauma fatalities. Forensic Imaging 2020. [DOI: 10.1016/j.fri.2020.200389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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3
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Abstract
AbstractA 64-year-old man was found dead in bed in his flat. In his right hand he held a bicycle pump to which a small-gauge cannula was attached and two fresh puncture wounds were found on his left hand. During the autopsy an air embolism of ca. 50 ml air was detected in the right ventricle of the heart by means of an aspirometer. The air embolism could not be reliably detected in a thorax radiograph taken prior to autopsy. Blood in the right ventricle was foamy. Pathological changes to organs were not found. Aside from the puncture wounds, there were no signs of externally applied mechanical force. The results of the toxicological analyses were negative.
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Johnson GA, Smith P, Robinson J, Collis SA, Johnson CP. The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism. Med Sci Law 2018; 58:176-182. [PMID: 29996706 DOI: 10.1177/0025802418785709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pathologists providing a coronial autopsy service are very reliant on the information, including that concerning the body at the scene, provided prior to the post-mortem examination. This ensures the case is appropriate for a non-forensic autopsy and allows proper interpretation of the pathological and laboratory findings. We present the results of an audit of the extent and accuracy of the information provided (in terms of a set of descriptors), in relation to the body at the scene; whether just the information on the coronial autopsy request form 97a is used, or if it is supplemented with details from the police form 97 and statements from attending officers and scene witnesses. The scene photographs were then reviewed to assess the accuracy of the other information sources and their value to the reporting pathologist. The audit showed that scene photographs are undertaken surprisingly frequently (29.6%) but this was only clear from the coronial request in 22% of referrals. More information was consistently available in the police information for most of the scene descriptors. This was usually accurate, but only partially so, with an average of 19% of relevant features. Viewing the scene photographs was deemed beneficial or essential in 51% and 41.1% of cases. The value of scene photography is then illustrated in a case of suspected suicidal venous air embolism, where subsequent review of the images pointed strongly to the rapidity of death, with minimal blood loss but obvious targeting of a very large varicose saphenous vein in the upper thigh.
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Affiliation(s)
- George A Johnson
- 1 Guy's, King's and St Thomas's School of Medical Education, King's College London, UK
| | - Philip Smith
- 2 Accident and Emergency Department, Aintree University Hospital NHS Foundation Trust, UK
| | - Jamie Robinson
- 3 Forensic Pathology Unit, Department of Pathology, Royal Liverpool University Hospital, UK
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Abstract
This case reports on a 68-year-old man who was found dead in hospital next to his bed. Before this, he had been treated with intravenous antibiotics for pneumonia. The body was found with a peripheral venous catheter connected to a nasal cannula delivering oxygen (O2) from the wall. Extensive medico–legal examinations were performed, including post-mortem computed tomography (CT), complete conventional autopsy, histological and immunohistochemistry analysis, toxicological analysis and post-mortem chemistry. Additionally, CT-guided gas sampling was performed at multiple sites to collect samples for gas analysis. During the external examination, massive subcutaneous emphysema was visible over the entire surface of the body. The CT scan revealed the presence of gas throughout the vascular system, and in the subcutaneous and muscular tissues. The autopsy confirmed the presence of lobar pneumonia and multiple gas bubbles in the vascular system. The gas analysis results showed a subnormal concentration of oxygen, confirming the suspected pure O2 embolism. Moreover, the carbon dioxide (CO2) concentration in the gas sample from the heart was elevated to a level similar to those found in scuba diving fatalities. This could come from degassing of dissolved CO2 that accumulated and was trapped in the cardiac cavity. Based on the results of the different exams performed, and especially the gas analysis results, it was concluded that the cause of death was O2 embolism.
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Affiliation(s)
- Lionel Comment
- Forensic Medicine Unit, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Vincent Varlet
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Kewin Ducrot
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
| | - Silke Grabherr
- Unit of Forensic Imaging and Anthropology, University Center of Legal Medicine, CHUV Hospital, Lausanne-Geneva, Switzerland
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Garetier M, Deloire L, Dédouit F, Dumousset E, Saccardy C, Ben Salem D. Postmortem computed tomography findings in suicide victims. Diagn Interv Imaging 2017; 98:101-112. [DOI: 10.1016/j.diii.2016.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/05/2023]
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7
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Simon G, Rácz E, Mayer M, Heckmann V, Tóth D, Kozma Z. Suicide by Intentional Air embolism. J Forensic Sci 2016; 62:800-803. [PMID: 27907236 DOI: 10.1111/1556-4029.13320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/14/2016] [Accepted: 08/06/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Gábor Simon
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Evelin Rácz
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Mátyás Mayer
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Veronika Heckmann
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Dénes Tóth
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
| | - Zsolt Kozma
- Department of Forensic Medicine; Faculty of Medicine; University of Pécs; 12 Szigeti street Pécs, H-7624 Hungary
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Yanagawa Y, Kondo A, Yoshizawa T, Jitsuiki K, Miyake T, Ohsaka H, Sugita M. The Migration of Air into the Aorta from a Pneumothorax in a Patient with a Penetrating Injury of the Aorta. Aorta (Stamford) 2016; 4:102-104. [PMID: 28097188 DOI: 10.12945/j.aorta.2016.16.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/12/2016] [Indexed: 11/18/2022]
Abstract
A tree fell on the back of a 77-year-old male. A postmortem computed tomographic pan scan revealed systemic air embolism, multiple rib fractures with a penetrating injury to the aorta, pneumohemothorax, and air in the aorta. A massive amount of air entered the site of a penetrating injury of the aorta. This unique case adds one more cause to the list of documented etiologies of air in the aorta.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
| | - Toshihiko Yoshizawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Takahito Miyake
- Department of Orthopedics, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka Prefecture, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Nerima Hospital, Juntendo University, Nerima ku, Tokyo, Japan
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Varlet V, Smith F, Giuliani N, Egger C, Rinaldi A, Dominguez A, Chevallier C, Bruguier C, Augsburger M, Mangin P, Grabherr S. When gas analysis assists with postmortem imaging to diagnose causes of death. Forensic Sci Int 2015; 251:1-10. [DOI: 10.1016/j.forsciint.2015.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Laurent P, Coulange M, Mancini J, Bartoli C, Desfeux J, Piercecchi-marti M, Gorincour G. Postmortem CT Appearance of Gas Collections in Fatal Diving Accidents. AJR Am J Roentgenol 2014; 203:468-75. [DOI: 10.2214/ajr.13.12063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Laurent PE, Coulange M, Bartoli C, Louis G, Souteyrand P, Gorincour G. Retrograde cerebral venous air embolism: a rare cause of intracranial gas. Diagn Interv Imaging 2014; 95:1113-5. [PMID: 24589189 DOI: 10.1016/j.diii.2013.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- P-E Laurent
- Laboratoire d'imagerie interventionnelle expérimentale, faculté de médecine, Aix-Marseille université, boulevard Jean-Moulin, 13385 Marseille cedex 5, France; Pôle imagerie médicale, Assistance publique des Hôpitaux de Marseille, 13385 Marseille cedex 5, France.
| | - M Coulange
- Service de médecine Hyperbare, pôle RUSH, hôpital Ste-Marguerite, 270, boulevard Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - C Bartoli
- Service de médecine légale et droit à la santé, hôpital Timone, Assistance publique des Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - G Louis
- Laboratoire d'imagerie interventionnelle expérimentale, faculté de médecine, Aix-Marseille université, boulevard Jean-Moulin, 13385 Marseille cedex 5, France; Pôle imagerie médicale, Assistance publique des Hôpitaux de Marseille, 13385 Marseille cedex 5, France
| | - P Souteyrand
- Laboratoire d'imagerie interventionnelle expérimentale, faculté de médecine, Aix-Marseille université, boulevard Jean-Moulin, 13385 Marseille cedex 5, France; Pôle imagerie médicale, Assistance publique des Hôpitaux de Marseille, 13385 Marseille cedex 5, France
| | - G Gorincour
- Laboratoire d'imagerie interventionnelle expérimentale, faculté de médecine, Aix-Marseille université, boulevard Jean-Moulin, 13385 Marseille cedex 5, France; Pôle imagerie médicale, Assistance publique des Hôpitaux de Marseille, 13385 Marseille cedex 5, France
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