Regarding “Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography”

Forensic Science, Medicine, and Pathology, Apr 2018

Vladimir Živković, Danica Cvetković, Slobodan Nikolić

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Regarding “Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography”

Regarding “Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography” Vladimir Živković 0 Danica Cvetković 0 Slobodan Nikolić 0 0 Institute of Forensic Medicine, University of Belgrade - School of Medicine , 31a Deligradska str, Belgrade 11000 , Serbia 1 Slobodan Nikolić Acknowledgments This work was supported by Ministry of Science of Republic of Serbia, Grant No. 45005. - We read with interest the article by Edler et al. entitled “Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography” [ 1 ], which describes a case of unusual fatal air embolism in an 83-year-old woman. The authors mentioned several autopsy findings indicating air embolism, one of them being air locks in cerebral vessels. In this paper Fig. 7 shows small bubbles of air, clearly visible in the cerebral vessels [ 1 ]. However, air locks in these – pial vessels, cannot be taken as an indubitable sign of an air embolism. This sign was described as a common artifact in (at least) three major textbooks. In “Knight’s Forensic Pathology” it is stated that in cases of suspected air embolism, the head should be dissected first, “not to detect air bubbles in the cortical veins, as almost every textbook erroneously states, but to look for air in the cerebral arteries”. It is also stated, in a critical manner, that “descriptions and photographs of air segments in the cerebral veins are part of the mythology of forensic pathology, handed on uncritically from one book and one author to another” and concluded that the bubbles in pial vessels are artifacts that can be seen in many routine autopsies where there is no suggestion of an air embolism being present [ 2 ]. In “Forensic Pathology” by DiMaio and DiMaio, it is explained that the process of removing the skull cap, cutting through the dura, and putting traction on the brain to see the cerebral circulation might introduce air bubbles into the circulation, and therefore, the presence of a few air bubbles in the cerebral circulation does not necessarily indicate an embolus 1. Edler C , Klein A , Püschel K , Schröder AS . Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography . Forensic Sci Med Pathol . 2018 ; https://doi.org/10.1007/s12024- 018-9961-2. 2. Saukko P , Knight B . Complications of injury . In: Saukko P, Knight B . Knight's forensic pathology . 3rd ed. London: Arnold; 2004 . pp. 339 - 352 . 3. DiMaio VJM , DiMaio DJ . Emboli. In: DiMaio VJM, DiMaio DJ . Forensic pathology . 2nd ed. Boca Raton: CRC Press; 2001 . pp. 453 - 464 . 4. Spitz WU . Selected procedures at autopsy . In: Spitz WU , Fisher RS , editors. Medicolegal investigation of death: guidelines for the application of pathology to crime investigation . Springfield: Charles C. Thomas; 2006 . p. 1243 - 74 .


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Vladimir Živković, Danica Cvetković, Slobodan Nikolić. Regarding “Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography”, Forensic Science, Medicine, and Pathology, 2018, 1-1, DOI: 10.1007/s12024-018-9976-8