title: Case report of fatal complication in prostatic cryotherapy. First reported death due to argon gas emboli.
abstract: We present the first reported fatality from argon gas emboli during prostate cryosurgery. The decedent underwent cryotherapy for prostate carcinoma using cryoablation probes which were cooled with argon and nitrous oxide and warmed with helium. Minutes into the procedure he experienced sudden cardiovascular collapse and could not be resuscitated. Postmortem examination was performed at the request of family and healthcare providers. Collection of tissues and blood samples had to be conducted carefully to capture suspected noble gases,argon, and helium. Specimens were submitted to Saint Louis University Forensic Toxicology Laboratory for toxicological examination and for evaluation of the composition of the gas retrieved from the vascular system.Gas chromatography mass spectrometric analyses confirmed argon in blood, brain, liver, and gas retrieved from the aorta. These samples had significant argon compared with room air also sent for comparison. The manner of death was accident. To date, there have been no intraoperative surgical fatalities reported from prostatic cryotherapy. We report such an unfortunate death to raise awareness in the medical community. We also describe how to collect and handle blood and tissue samples to submit for toxicological analysis in cases of volatile gas emboli.
authors.affiliation: Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO 63134, USA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Sandomirsky
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Crifasi
authors.forename: Christopher
authors.initials: C
authors.lastname: Long
authors.forename: Erik K
authors.initials: EK
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001011:Aorta / Q000737:chemistry; D001128:Argon / Q000009:adverse effects* / Q000032:analysis; D001923:Brain Chemistry; D002277:Carcinoma / Q000601:surgery; D003452:Cryosurgery / Q000009:adverse effects*; D004618:Embolism, Air / Q000209:etiology*; D049429:Forensic Pathology; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007431:Intraoperative Complications; D008099:Liver / Q000737:chemistry; D008297:Male; D011471:Prostatic Neoplasms / Q000601:surgery*; D011651:Pulmonary Artery / Q000737:chemistry
chemical_list: D001128:Argon