Air embolism following arthroscopy--autopsy findings and forensic medicine aspects

An iatrogenic cause of air embolism with a fatal outcome is reported that occurred in a case in which arthroscopy of the knee had been carried out. Even after worldwide use of arthroscopy for many years, this complication has never been seen until now. At autopsy, when air bubbles were observed in the right heart chamber and in the vena cava inferior, only the knee joint was taken into consideration as the air-access route. The access of air was detected by means of arthroscopy on the corpse, combined with a special autopsy technique and shown experimentally. Insufflated air had entered via a fracture of the tibial articular surface and then passed through the spongiosa into the femoral vein. These findings are of far-reaching clinical consequence because the indication for arthroscopy by gas insufflation must be reconsidered again. Finally, the medicolegal aspects of such an incident are discussed.