11 year-old girl undergoing scoliosis surgery

We report the case of an 11-year-old girl operated on for a severe left thoracolumbar scoliosis. Pedicular screw insertion and rod positioning was technically successful, but five days later, for signs of an early infection, the wound revised and unexpectedly the patient died during surgery. Autopsy recognized a diffuse cerebral cortical venous air embolism as the cause of death and excluded pulmonary embolism and associated cardiac defects.This is the first and unique case describing a fatal paradoxical air venous cerebral embolism in a pediatric patient undergone spine surgery: the possible mechanism involving azygos and jugular veins systems is discussed.