Acute decompression sickness--report of an autopsy case with widespread fat embolism

A case of acute decompression sickness presenting severe clinical features was reported. At the time of autopsy, intra- and extravascular air bubbles were found in various organs. Pulmonary fat embolism was also prominent in association with severe circulatory disturbances of the lungs. The spinal cord showed edematous and congestive swelling which was intimately related to the coagulation of blood within the epidural veins that contained innumerable fat droplets. Intravascular fat seemed to be created in and released from the injured adipose tissue, especially that of the bone marrow during decompression and to have acted as an accelerator of intravascular coagulation. The pathophysiological significance of the fat embolism for the development and the progression of decompression sickness is discussed.