CT pneumoangiogram sign following cardiopulmonary resuscitation: detrimental cerebral air embolism or postmortal blood replacement with air?

Abstract

Massive air in the cerebral vessels (pneumoangiogram) on postmortal computed tomography (CT) examination after cardiopulmonary resuscitation of a 10-year-old child with severe thoracic trauma is reported and possible mechanism of pneumoangiogram is discussed. The patient suffered from severe head and chest injury and was transported to hospital in a cardiopulmonary arrest state. Cardiopulmonary resuscitation was not successful and to find the cause of death, postmortal cranial CT and supine chest X-radiography were performed. Chest X-ray revealed almost total obliteration of left pulmonary aeration as well as pneumomediastinum and bilateral hydropneumothorax. On CT scans, diffuse air was seen in the carotid arteries, middle and anterior cerebral arteries, the vertebral arteries, and in the right sigmoid sinus. This pneumoangiogram sign is believed to be the end result of pumped pneumothorax–pneumomediastinum air which was sucked through the lacerated thoracic great vessels via cardiac massage, replacing the emptied cerebral vessel lumens previously depleted of blood through massive thoracic hemorrhage and has nothing to do with a death contributing detrimental cerebral air embolism.