Fujioka Masaki, Niino Daisuke, Ito Masahiro, Matsuoka Yohjiro
Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Kubara 2 Ohmura City, Nagasaki Prefecture, Japan.
J Forensic Sci. 2012 Jul;57(4):1118-9. doi: 10.1111/j.1556-4029.2012.02094.x. Epub 2012 Feb 28.
The recognition and visualization of an arterial gas embolism are difficult. We report a case of sudden death caused by paradoxical air embolism of coronary and cerebral arteries, diagnosed by the pre autopsy computed tomography (CT) scanning. A 54-year-old woman suddenly died after the self-removal of the jugular vein catheter. Postmortem imaging examination using CT scanning showed multiple gas embolisms in the cerebral arteries, pulmonary artery, right atrium and ventricle, left ventricle, aorta, and coronary arteries. These findings suggested that the occurrence of acute ischemia of the brain and heart caused by massive air inflow to the artery. Conventional autopsy revealed a patent foramen ovale of the heart. These results indicated that the patient died of paradoxical air embolization of the coronary and cerebral arteries through a patent foramen ovale because of right-to-left shunting. The use of postmortem imaging as an aid for conventional autopsy has proved to be of advantage in the case of gas embolism.
动脉气体栓塞的识别和可视化很困难。我们报告一例因冠状动脉和脑动脉矛盾性空气栓塞导致猝死的病例，通过尸前计算机断层扫描（CT）确诊。一名54岁女性在自行拔除颈静脉导管后突然死亡。CT扫描的尸检后影像学检查显示脑动脉、肺动脉、右心房和心室、左心室、主动脉和冠状动脉中有多处气体栓塞。这些发现提示大量空气流入动脉导致脑和心脏急性缺血的发生。传统尸检发现心脏卵圆孔未闭。这些结果表明，患者因右向左分流通过未闭卵圆孔死于冠状动脉和脑动脉的矛盾性空气栓塞。在气体栓塞的病例中，使用尸检后影像学辅助传统尸检已证明具有优势。
