Post-mortem computed tomography in a case of suicide by air embolism

Laurent, Pierre-Eloi; Coulange, Mathieu; Desfeux, Jacques; Bartoli, Christophe; Coquart, B.; Vidal, Vincent; Gorincour, Guillaume

doi:10.1016/j.diii.2013.01.014

Cited by 14 publications

(9 citation statements)

References 9 publications

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“…Consequently, the CT scans can be interpreted by the forensic radiologist/pathologist to support gas embolism as the cause of death. The very high O 2 concentrations and CT scan results are consistent with a pure O 2 fatal gas embolism [ 15 ]. The CO 2 levels observed are consistent with the data found in the literature.…”

Section: Discussionmentioning

confidence: 72%

A fatal case of oxygen embolism in a hospital

Comment

Varlet

Ducrot

et al. 2017

Forensic Sciences Research

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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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Section: Discussionmentioning

confidence: 72%

A fatal case of oxygen embolism in a hospital

Comment

Varlet

Ducrot

et al. 2017

Forensic Sciences Research

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“…All previously reported suicidal cases of air embolism were committed by either victims with a medical profession or by victims under medical treatment , in which cases they could obtain the necessary equipment easily. The statistics also show that the favored method of suicide is in correlation with the availability of the different lethal tools .…”

Section: Resultsmentioning

confidence: 99%

“…The main causes of venous air embolism are medical procedures , especially insertion and removal of venous catheters , neurosurgery , cesarean delivery , and therapeutic abortion . Other common causes of air embolism include neck and head trauma and also injuries of the genitals , but self‐induced suicidal (and intentional) air embolism is extremely rare .…”

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confidence: 99%

Suicide by Intentional Air embolism

Simon

Rácz

Mayer

et al. 2016

Journal of Forensic Sciences

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Venous air embolism occurs when air enters the venous system. The main causes of venous air embolism include medical procedures, neck and head trauma, and injuries of the genitals. Self-induced suicidal (and intentional) air embolism is extremely rare. The authors report a rare case of a suicidal air embolism committed using a self-made tool composed of a plastic bottle and an infusion set, injecting nearly 2000 mL of air into the cubital vein. The toxicological analysis suggested that midazolam, together with air, was also injected into the circulation using the same bottle and infusion set.

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“…13,18 Previously published cases of intentional suicidal AE are reported to have been committed by members of the medical profession or by patients under medical treatment. [19][20][21] Whether it was the intention of the deceased in the case report presented here, to induce fatal venous AE remains unclear, although there are observations to support this as a reasonable possibility. The individual had clearly targeted the large dilated varicosity on his leg and the group of small superficial abrasions on the neck, which were also overlying the anatomical position of the large neck veins.…”

Section: Discussionmentioning

confidence: 99%

The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism

et al. 2018

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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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Post-mortem computed tomography in a case of suicide by air embolism

Cited by 14 publications

References 9 publications

A fatal case of oxygen embolism in a hospital

A fatal case of oxygen embolism in a hospital

Suicide by Intentional Air embolism

The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism

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