Massive gas embolism revealed by two consecutive postmortem computed-tomography examinations

We present a case of unusual gas embolism in a 73-year-old man who was found in a state of cardiopulmonary arrest with an oxygen-supply tube connected to an intravenous catheter inserted into his median cubital vein. Postmortem computed tomography (PMCT) performed 27h after death showed systemic gas distribution including intravascular gas, pneumothorax, pneumoperitoneum, pneumomediastinum, pneumoretroperitoneum and gastric emphysema. A second PMCT scan performed 116h after death showed a marked decrease of air inside the body. The current case shows the importance of PMCT for visualization, quantification, and preservation of evidence for establishment of the cause of death in cases with suspected gas embolism. Our findings also indicate that performance of two PMCT examinations may be useful for differentiation of embolized gas from gas produced by putrefaction.