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CASE REPORT
Delayed lethal pulmonary air embolism after a gunshot head injury
  1. Jakob Emanuel Brune1,
  2. Denis Laurent Kaech2,
  3. Daniel Wyler3,
  4. Raphael Jeker1
  1. 1Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland
  2. 2Department of Neurosurgery, Kantonsspital Graubunden, Chur, Switzerland
  3. 3Institute of Legal Medicine, Kantonsspital Graubunden, Chur, Switzerland
  1. Correspondence to Dr Jakob Emanuel Brune, jakob.brune{at}gmail.com

Summary

We present a case of a young male patient with a fatal pulmonary air embolism following a penetrating gunshot head injury. He suffered from severe head trauma including a laceration of the superior sagittal sinus. Operative neurosurgical intervention did not establish a watertight closure of the wounds. Eight days after the trauma, the patient suddenly collapsed and died after an attempt to mobilise him to the vertical. Forensic autopsy indicated pulmonary air embolism as the cause of death. Retrospectively, we postulate an entry of air to the venous system via the incompletely occluded wounds and the lacerated superior sagittal sinus while mobilisation to the vertical created a negative pressure in the dural sinus.

  • trauma
  • adult intensive care
  • trauma cns /pns
  • neurosurgery

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Footnotes

  • Contributors RJ had the idea and is the guarantor for the article. DLK and RJ managed the case. DW performed forensic autopsy. JEB performed the literature research and wrote the article. DLK, DW and RJ edited and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.