Abstract

Massive vascular gas embolism is a feared and often lethal symptom of decompression illness, resulting from diving accidents. The aim of this case report was to correlate post-mortem computed tomography scan (PMCT) findings with autopsy in cases of massive vascular gas embolism. Two cases of fatal diving accidents were retrospectively selected from a forensic radiological pathological database. The PMCT results were initially shared with the forensic pathologist prior to autopsy, enabling a more accurate overall assessment. Both cases were in retrospect thoroughly studied to compare the PMCT findings with the autopsy results. In general, intra- and extra-vascular gas collections are easily detected on PMCT in all body regions. We focused on abundant intravascular gas collections, mainly in the large brain vessels. General autopsy findings are described in both cases, and in one case we elaborate on specific intracerebral changes found at autopsy. Both cases were diagnosed as pulmonary barotrauma with subsequent vascular gas embolisms. We conclude that PMCT excels in the detection of macroscopic gas collections in the body, whereas microscopic gas collections identified at autopsy aid in the differentiation between decompression sickness and pulmonary barotrauma followed by vascular gas embolism. The presented cases highlight the advantages of using both PMCT and autopsy in the post-mortem evaluation of fatal diving accidents.


Author Details

Authors

• Henri M. de Bakker¹
• Bela Kubat^{2, 3}
• Vidija Soerdjbalie-Maikoe³
• Marloes Vester^{3, 4}
• Olga J.G.B. de Bakker⁵
• Rob A. van Hulst⁶
• Bernadette S. de Bakker⁷

Departments

• ¹ Department of Radiology, Groene Hart Hospital, Gouda,
• ² Department of Pathology, Maastricht UMC+, Maastricht,
• ³ Division of Special Services, Section Forensic Pathology, Netherlands Forensic Institute, The Hague,
• ⁴ Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam,
• ⁵ Hippocampus Medicus, Medical Examinations for Divers, Gouda,
• ⁶ Department of Anesthesiology, Hyperbaric Medicine, and
• ⁷ Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

Address

Bernadette S. de Bakker, MD, PhD
Department of Medical Biology
Section Clinical Anatomy & Embryology
Meidbergdreef 9
1105AZ Amsterdam, The Netherlands
Email: [email protected]

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