title: Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist.
abstract: Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis.
authors.affiliation: Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Marchesi
authors.affiliation: Università degli Studi di Milano Bicocca, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Battistini
authors.affiliation: Università degli Studi di Milano Bicocca, Italy.
authors.forename: Moira
authors.initials: M
authors.lastname: Pellegrinelli
authors.affiliation: Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Italy.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Gentile
authors.affiliation: Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Italy riccardo.zoia@unimi.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Zoja
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D049429:Forensic Pathology; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged
keywords: Forensic pathology; forensic medicine