Arterial air emboli on computed tomography (CT) autopsy

Area of Science:

• Radiology
• Forensic Pathology
• Medical Imaging

Background:

• Distinguishing systemic air emboli from postmortem intravascular gas is crucial in forensic and trauma imaging.
• Computed tomography (CT) autopsy offers detailed visualization of internal structures, aiding in the identification of gas within the vasculature.

Observation:

• A review of 15 CT autopsies identified four cases with intravascular gas.
• Three cases demonstrated predominantly arterial intravascular air, associated with significant pulmonary injury.
• One case showed predominantly venous intravascular air, with extensive gas noted in the portal veins.

Findings:

• The radiological appearance of intravascular air on CT autopsy can vary.
• Systemic air emboli, characterized by arterial gas, are linked to severe pulmonary injury.
• Venous air, particularly in the portal system, may have different etiologies.

Implications:

• Pulmonary alveoli-venous fistula is proposed as a potential cause for systemic air emboli identified on CT autopsy.
• CT autopsy findings of arterial gas and pulmonary injury warrant consideration of this fistula.
• Further research can refine the differentiation between antemortem and postmortem intravascular gas on CT imaging.