Fatal Massive Air Embolism Following Penetrating Infraorbital Trauma From a High-Pressure Industrial Pump Component:...

Air embolism is an uncommon but well-recognized cause of sudden death, most frequently encountered in iatrogenic settings. Traumatic air embolism is rare and typically associated with injuries of the head, neck, or thorax. We report an exceptional occupational fatality caused by massive systemic air embolism following penetrating facial trauma. A high-pressure industrial pump component ruptured and was propelled into the worker's right infraorbital region, producing fractures of the orbital floor and skull base with laceration of the right cavernous and sigmoid venous sinuses. Autopsy revealed extensive intravascular and extravascular gas throughout the body, including the heart, abdominal tissues, and subcutaneous planes. Gas aspirated from the right atrium was analyzed by gas chromatography-mass spectrometry and demonstrated an air-like composition consisting of nitrogen, oxygen, and carbon dioxide. No alternative lethal, traumatic, or natural pathology was identified. This case highlights a rare anatomic portal for the forced entry of air into the venous system. It further demonstrates the value of combined autopsy, radiologic, and chemical analyses in the forensic diagnosis of fatal air embolism.