Post-traumatic venous and systemic air embolism associated with spinal epidural emphysema: multi-slice computed tomography diagnosis.
A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. Air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism.
Dedouit
Fabrice
F
Institut de Médecine Légale et de Médecine Sociale, Medecine Legale, Place de Verdun, 59145 Lille Cedex, France. fabded2@hotmail.com
Otal
Philippe
P
Loubes-Lacroix
Florence
F
Rousseau
Hervé
H
Costagliola
Rémi
R
Telmon
Norbert
N
Joffre
Francis
F
Rouge
Daniel
D
D000063:Accidents, Traffic; D000328:Adult; D003288:Contusions / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D004618:Embolism, Air / Q000000981:diagnostic imaging*; D004646:Emphysema / Q000000981:diagnostic imaging*; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005554:Forensic Medicine; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging; D055370:Lung Injury; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging; D013122:Spinal Diseases / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*