骨盆骨折后并发肺脂肪栓塞死亡1例

1案例资料焦某,男,55岁。2004年3月13日被三轮车撞伤腰部,当即被送往医院诊治。据首诊医院病历记载,2004年3月13日,焦某因车祸致腰骶部、下腹疼痛2h入院。查体:骨盆周围肌肉压痛,骨盆挤压试验阳性,尿道口有鲜血流出。X线片报告骨盆耻骨多发骨折。诊断:骨盆多发性骨折(粉碎性);尿道损伤。3月26日家属要求转院治疗。在转院后医院病历中,记载焦某因碰伤致骨盆部肿痛,双下肢活动受限13d收入院。入院拍片后突然出现呼吸困难,抬入病房呈叹气样呼吸,双瞳孔散大,抢救无效死亡。尸检见右颞部有5cm×3cm表皮剥脱(已结痂),右脚背外侧有2.1cm×3.1cm表…     

胫腓骨骨折并发肺脂肪栓塞死亡1例

1案例资料 1．1简要案情 罗某，男，22岁。某日凌晨2时因车祸受伤。伤后2h，人院检查：T36．80C，P110次／min，R22次／min，Bp11．2／8．0kPa（84／60mmHg），诊断为右侧胫腓骨中段粉碎性骨折。拟行骨折复位内固定术，但术前伤者出现躁动、呼吸困难、心跳加快、血压下降，经抢救无效死亡。     

20例脂肪栓塞死亡的法医学分析

目的分析脂肪栓塞综合征（fatembolismsyndrome,FES）死亡的一般情况以及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法选取某大学法医学鉴定中心1999—2012年20例FES死亡案件．对其一般情况及法医病理学特点（包括致伤方式、损伤类型、临床表现、病理学改变等方面）进行总结。结果脂肪栓塞主要见于损伤导致的长骨骨折和全身大面积软组织损伤,主要类型为肺脂肪栓塞,偶见合并脑脂肪栓塞。症状多出现在伤后和术后较短时间内,组织病理学检查可在肺小血管内检见大量脂滴并经特殊染色证实。结论FES死亡案例在损伤类型、脂肪栓塞出现症状时间及组织病理学表现等方面均有一定规律和特点。在鉴定中应注意进行特殊染色（油红0染色）处理,寻找FES的直接证据。     

胸骨骨折并发肺脂肪栓塞死亡1例

肺脂肪栓塞常并发于长骨骨折和软组织挫伤,而胸骨等扁平骨骨折并发肺脂肪栓塞且在短时间内死亡的案例较少见,现报道1例:1案例资料刘某,女,58岁。2005年8月10日晚9时许,被发现死于自家楼梯口处,尸体俯卧于米袋上,现场地面上有较多撒落的米。经调查,死者患有精神分裂症近30年,期间服用抗精神病药并多次发作,死前有发作,晚上不睡觉,抱米袋上下楼行走。尸体检验死后60h尸检。死者衣着整齐,左额部有5cm×1.5cm条形擦伤,右额部有0.8cm×0.5cm表皮剥脱,皮下无出血。枕部头皮下有6.5cm×3.5cm出血,颅骨无骨折,脑无挫裂伤。胸骨柄体结合处有5cm×4cm…     

外伤42天后肺脂肪栓塞猝死1例

1案例资料1.1简要案情及病历资料某年1月10日,某男在公交车上制止小偷绺窃时,被匕首刺伤背部、右大腿外侧,遂被送到市中医院住院治疗。1月10日入院急诊病历记载:安某,男,47岁,体健。Bp10/7.5 kpa,R24次/分,P90次/分,T37℃;精神差,神志清,出血量约600ml。专科检查:背部右侧有一1.5cm创口,刺入胸腔,右大腿股骨外侧有两处创口,长度1.5~2.0cm,下面的一处深约4.0cm,刺断肌腱、股外侧浅静脉。听诊:右侧肺呼吸音弱,心率弱。X线示:右侧少量血气胸,肋膈角液平。给予吸氧,胸腔闭式引流对症治疗。术后病情一直稳定。2月17日后未用任何药物。20日13时,…     

广泛性软组织挫伤后肺脂肪栓塞1例

广泛性软组织挫伤后一般是由于继发休克、弥漫性血管内凝血（DIC）或者挤压综合征而导致死亡［1～3］,引起肺脂肪栓塞则少见。广泛性软组织挫伤后因血液中脂肪释放引起肺脂肪栓塞致死则更为罕见,笔者曾遇一例,现予以报道如下:     

胫腓骨骨折内固定术后并发肺脂肪栓塞死亡1例

1案例1．1简要案情某女，64岁。于某年8月15日因车祸致伤左小腿入住当地县医院．X线片示左侧胫腓骨中下段粉碎性骨折，并予支架外固定等对症治疗。2d后因“车祸致左小腿肿痛、畸形、活动受限2d”入住某医院。入院查体：BP19．73／13．07kPa（148／98mmHg），神志清楚，     

脂肪栓塞的检验方法

在法医学病理学检验实践中 ,确定脂肪栓塞常采用冰冻切片苏丹Ⅲ /Ⅳ染色法或者锇酸染色法。以往报道的方法 ,或需恒温冰冻切片机 ,或需昂贵的锇酸[1、2 ] ,对于国内大多数法医学病理实验室来说都难于实现。本研究尝试用不同试剂和不同方法处理检材 ,旨在获得简便易行 ,且不需要昂贵设备或试剂的脂肪栓塞的检验方法。1　材料与方法1 1　材料检材取自多发性骨折后 ,证实死者因脂肪栓塞而死的肺组织。用同一组织块取材做冰冻切片 ,取粥样硬化明显的冠状动脉 (包含血管周围脂肪组织 )做阳性对照和取因溺水而死亡者的肺组织做阴性对照。所取组织…     

多发性指骨骨折致肺脂肪栓塞猝死1例

<正>1案例资料1.1简要案情死者男,42岁,农民。于2006年9月11日上午7时,被其弟以松木棍殴打致失去抵抗能力后弃于山林中。当日10时左右,被人发现已死亡。据查:死者平时午、晚餐各饮酒100～150 mL,持续约10～15年。1.2尸体检验     

左股骨横断骨折致肺脂肪栓塞急死1例

1案例资料1.1简要案情某男,15岁,某日晚乘坐二轮摩托车与一辆自行车追尾相撞摔倒受伤,司机急将其抱至摩托车后座上驾车逃逸并将其遗弃路旁,2h后发现死亡。1.2尸体检验尸长163cm,尸斑位于背部未受压处,指压褪色,尸僵存在。头皮无损伤,瞳孔散大等圆,直径0.6cm。口、鼻腔及两外耳道无异常。额区中下部,鼻根部,鼻尖部各有1处表皮剥脱、皮下出血,面积分别为3.0cm×2.2cm、1.2cm×1.0cm、1.0cm×1.0cm,并触及鼻骨骨折;上口唇有2处1.0cm×0.2cm、1.3cm×0.2cm的创口,创缘不整;左颧部外上方有4.7cm×4.0cm的表皮剥脱、皮下出血。腰部散在皮下淤血,伴…     

α-纤维蛋白原基因多态性与肺动脉栓塞相关性初探

目的探讨α-纤维蛋白原Thr312Ala基因的多态性分布与肺动脉栓塞的相关性。方法选取尸检已确诊的肺动脉栓塞病例的甲醛固定心肌组织14例和正常健康人群外周血56例,采用改良酚-氯仿法和Chelex100法分别提取心肌组织和外周静脉血基因组DNA,用PCR-RFLP法检测α-纤维蛋白原基因Thr312Ala多态性,并分析其与肺动脉栓塞的关联性。结果α-纤维蛋白原Thr312Ala基因的各基因型在肺动脉栓塞组与对照组比较差异具有显著性意义（P〈0.05）;各等位基因在两组间比较差异具有显著性意义（P〈0.05）;A等位基因与PE呈负相关（RR=0.475,P〈0.05）;G等位基因与PE呈正相关（RR=5.818,P〈0.05）。结论α-纤维蛋白原基因Thr312Ala位点G等位基因与肺动脉栓塞有正关联,肺动脉栓塞死亡者中GA、GG基因型分布频率较高,本文数据可为相关研究提供参考。     

Massive systemic fat embolism detected by postmortem imaging and biopsy*

Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image-guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image-guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image-guided biopsy, may detect the cause of death prior to traditional autopsy.     

Fat embolism syndrome associated with atraumatic compartment syndrome of the bilateral upper extremities: An unreported etiology

Fat embolism syndrome (FES) is a potentially life-threatening condition that develops when fat embolism leads to clinical symptoms and multisystem dysfunction. The classic triad of respiratory distress, neurologic symptoms, and petechial rash are non-specific, and the lack of specific laboratory tests makes the diagnosis of FES difficult. Although FES is most common after long bone fractures, multiple conditions some of which are atraumatic have been associated with the development of FES. We report a case of FES that occurred in the setting of a non-traumatic compartment syndrome of the upper extremities. The pathologic and clinical findings, pathophysiology, diagnostic challenges, and pathologic methods to properly diagnose FES are discussed with a review of the relevant literature. This case highlights the importance of the autopsy in making a diagnosis of FES in cases where death could otherwise be incorrectly attributed to multi-organ system failure, shock, or sepsis.     

静脉气体栓塞的研究进展

气体栓塞是一种较多见而又威胁生命的医疗操作并发症,在法医学实践中也时有所遇,但易被检验者所忽略;也常因尸体放置较久而给法医学检验和鉴定带来困难。在此综述了静脉气体栓塞的病因、病理生理变化、临床表现及诊断和法医学鉴定的意义及注意事项,认为超声心动图、CT和MRI等现代成像技术在气体栓塞的临床诊断和法医学鉴定中有积极的辅助作用。     

羊水栓塞诊断的方法学研究进展及法医学意义

羊水栓塞(amniotic fluid embolism,AFE)是指分娩过程中羊水进入母血循环,引起肺栓塞、休克甚至死亡等一系列严重症状的综合征。目前对于AFE的诊断为排除性诊断,方法缺乏灵敏性和特异性。因此随着以AFE为死因的孕产妇病死率的升高,寻找更精确的AFE诊断方法成为了法医学研究的重点。本文结合相关文献概述了AFE诊断方法的研究进展,希望能为法医学鉴定提供方法学参考。     

脂肪栓塞中苏丹Ⅲ染色的定量分析

目的探讨苏丹Ⅲ染色如何定量应用于脂肪栓塞的法医学鉴定。方法应用苏丹Ⅲ对11例肺脂肪栓塞猝死的案例和11例其他原因致死的案例进行染色,并结合统计学方法对脂肪栓塞的阳性面积百分率及脂肪栓子数进行定量分析。结果脂肪栓塞致死者肺内苏丹Ⅲ染色阳性面积百分率为（5±1．7）％、脂肪栓子数为（9±2．4）％,均远大于其他原因致死的案例（P〈0．01）。结论苏丹Ⅲ染色法定量分析在脂肪栓塞中的法医学鉴定上结果可靠。     

16例肺血栓栓塞猝死的法医学分析和临床研究

目的分析肺动脉血栓栓塞（pulmonary thromboembolism,PTE）猝死的法医病理学特点,探讨医疗过程中发生PTE的危险因素,为临床预防、治疗提供帮助。方法对本市2002年至2009年16例PTE猝死案件进行回顾性分析。结果每例均至少存在1项已知的高危因素,其中外伤12例,慢性疾病长期卧床1例,手术3例;发病到死亡的时间平均为1.2h,6例≤1h,3例≤12h。结论对于高龄（≥40岁）外伤或手术患者,预防、早期诊断和治疗PTE对于患者的生命至关重要,发现深静脉血栓形成者应采取紧急手段处理栓塞,谨防发生PTE致猝死。     

Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model

There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position.     

Suicide by Intentional Air embolism

Venous air embolism occurs when air enters the venous system. The main causes of venous air embolism include medical procedures, neck and head trauma, and injuries of the genitals. Self‐induced suicidal (and intentional) air embolism is extremely rare. The authors report a rare case of a suicidal air embolism committed using a self‐made tool composed of a plastic bottle and an infusion set, injecting nearly 2000 mL of air into the cubital vein. The toxicological analysis suggested that midazolam, together with air, was also injected into the circulation using the same bottle and infusion set.