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头部创伤的致命后果:一例静脉空气栓塞并发药物滥用和肝脏疾病的病例报告。

Fatal Consequences of Head Trauma: A Case Report of Venous Air Embolism Complicated by Substance Abuse and Liver Disease.

作者信息

Ferencic Antun, Mervic Martin, Zupanc Tomaz

机构信息

Institute of Forensic Medicine, School of Medicine, University of Ljubljana, Ljubljana, SVN.

出版信息

Cureus. 2024 Oct 18;16(10):e71754. doi: 10.7759/cureus.71754. eCollection 2024 Oct.

Abstract

Venous air embolism is a rare but potentially fatal complication arising from traumatic injuries or medical procedures, characterized by the intravascular introduction of air leading to the formation of gas emboli within the pulmonary vasculature and cardiac chambers. Here, we present the case of a 34-year-old female with a history of substance abuse who sustained a head injury during an altercation. Despite initial resistance to medical assistance due to intoxication, she eventually received treatment for a significant head wound. A postmortem examination revealed a triangular wound penetrating through the scalp layers, accompanied by extensive bruises indicative of trauma. Notably, air embolism was discovered in the venous and cardiac systems, primarily attributed to injury of the temporal vein near the head wound. This complication was most likely exacerbated by an underlying coagulation disorder stemming from mixed nodular cirrhosis of the liver. The failure of damaged veins to thrombose and inadequate occlusion of venous lumens might have further facilitated air ingress into the venous system, culminating in a fatal outcome. This case underscores the importance of recognizing and promptly managing head injuries, especially in patients with a history of substance abuse and coexisting medical conditions such as liver disease. Improved awareness and education regarding the risks of substance abuse and the significance of seeking timely medical intervention for traumatic injuries are crucial in preventing similar tragic consequences in the future.

摘要

静脉空气栓塞是一种由创伤性损伤或医疗程序引起的罕见但可能致命的并发症,其特征是血管内进入空气,导致肺血管和心腔内形成气体栓子。在此,我们报告一例34岁有药物滥用史的女性病例,她在一次争吵中头部受伤。尽管最初因中毒而抗拒医疗救助,但她最终因严重的头部伤口接受了治疗。尸检发现一个三角形伤口穿透头皮各层,伴有表明创伤的广泛瘀伤。值得注意的是,在静脉和心脏系统中发现了空气栓塞,主要归因于头部伤口附近颞静脉的损伤。这种并发症很可能因肝脏混合结节性肝硬化导致的潜在凝血障碍而加剧。受损静脉未能形成血栓以及静脉腔闭塞不足可能进一步促使空气进入静脉系统,最终导致致命后果。该病例强调了识别和及时处理头部损伤的重要性,尤其是在有药物滥用史和并存如肝病等医疗状况的患者中。提高对药物滥用风险的认识和教育,以及对创伤性损伤及时寻求医疗干预的重要性,对于预防未来类似的悲剧后果至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4c3/11570429/f108272d476b/cureus-0016-00000071754-i01.jpg

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