Abstract
Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.
Highlights
Gas gangrene is a necrotic infection of the soft tissue and muscles that progresses rapidly and it has high mortality rates
In approximately 80% of the cases, gas gangrene is caused by Clostridium perfringens which is a Gram-positive spore-forming bacillus commonly found in the soil and intestines of humans and animals [1, 2]
Traumatic gas gangrene occurs after crushtype injury, penetrating injury, gynecologic surgery such as abortion, and bowel/biliary tract surgery where bowel contents leak into the soft tissues
Summary
Gas gangrene is a necrotic infection of the soft tissue and muscles that progresses rapidly and it has high mortality rates. Yamaguchi et al reported the first autopsy case of fatal septicemia caused by gas-forming C. perfringens using PMCT findings. They combined conventional autopsy and PMCT to investigate a cadaver which was presented to the hospital in a cardiopulmonary arrest state and died [8]. We report a dialysis patient who died suddenly owing to gas gangrene In this case, we determined the diagnosis by PMCT. Physical examination showed that he had upper abdominal tenderness with normal bowel sounds He had left incomplete paralysis owing to prior cerebral infarction. The deceased patient developed skin blisters with a foul smell (Fig. 1d) Because his family refused a conventional autopsy, whole-body PMCT was performed within 70 min of his death. We presumed that the cause of death was gas gangrene caused by Clostridia species
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