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Fatal systemic (paradoxical) air embolism diagnosed by postmortem funduscopy.

Lucy M Bradley¹, Anna G McDonald², Patrick E Lantz²

¹Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.

Journal of Forensic Sciences

|June 16, 2021

Summary

Retinal air emboli (RAE) are a rare sign of systemic air embolism. This case report documents RAE in an infant, aiding in diagnosing fatal air embolism through postmortem examination.

Keywords:

air embolism forensic pathology paradoxical air embolism postmortem funduscopy postmortem indirect ophthalmoscopy retinal air embolism

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Area of Science:

Forensic Pathology
Ophthalmology
Pediatric Medicine

Background:

Systemic air embolism is frequently underdiagnosed.
Retinal air emboli (RAE) are a rare but distinctive sign of systemic air embolism.
Published literature lacks photographic documentation of RAE, particularly in pediatric cases.

Observation:

An infant presented unresponsive and later died despite resuscitation.
Postmortem funduscopy revealed diagnostic RAE.
Radiography and autopsy confirmed systemic paradoxical air embolism from inflicted blunt force trauma.

Findings:

This case report provides the first photographic evidence of RAE in an infant.
The findings illustrate classic RAE associated with fatal systemic air embolism.
RAE were detected during postmortem funduscopy.

Implications:

The detection of RAE can assist pathologists in diagnosing systemic air embolism.
This case highlights the importance of funduscopy in postmortem examinations.
Recognizing RAE can improve the diagnosis of air embolism in critical care and forensic settings.