15283-B-Blokker

94 Chapter 5 FIGURES Figure 1. Massive Air Embolus as Cause of Death Legend: 60-year old man who underwent bilateral lung transplantation two months before death. He developed postoperative delirium and was treated for pneumonia. Just prior to death he developed hypotension and agonal breathing. There were signs of elevated jugular venous pressure. Resuscitation during asystole was unsuccessful. The patient died under clinical suspicion of a central pulmonary embolus or cardiac tamponade. CA identified a possible myocardial infarction and thrombo-emboli as the cause of death, whereas MIA explained death by a massive air embolus. The reference standard committee concluded that MIA correctly identified the cause of death. Volume rendered PMCT image shows diffuse air in the intracranial arteries (left upper panel), in the thoracic aorta (right upper panel), and in visceral arteries of the upper abdomen (left lower panel). Microscopic image of the myocardium showing vessels inflated by air that pushes erythrocytes to the walls, and causes rupture of vessels (arrow), allowing air to escape into the interstitial space, thereby tearing the tissue (asterisks). (Hematoxylin and Eosin, original magnification 50x).