Arterial air emboli on computed tomography (CT) autopsy

To describe radiological appearances of systemic air emboli versus intravascular air from putrefaction.

The hospital trauma database was searched for patients who underwent computed tomography (CT) autopsy. The studies were reviewed and evaluated for intravascular gas. The appearances and location of intravascular air were characterised.

Four cases of intravascular gas were identified out of 15 cases of CT autopsy performed from March 2004 to December 2006. In three cases, intravascular air was predominantly in the arterial system, coupled with severe pulmonary injury. In one case, the air was predominantly in the venous system with a large amount of gas in portal veins.

We propose to consider pulmonary alveoli-venous fistula as a possible cause of systemic air emboli, as identified on CT autopsy by large amounts of gas in the arterial circulation, coupled with severe pulmonary injury.