Distinguishing cardiac gas embolism from postmortem lesions based on gas presence in various anatomical locations

Cardiac gas embolism is one of the most challenging pathologies to confirm in a postmortem diagnosis. It is defined as the entry of gas into the vascular system, which can occur in both the venous and arterial parts. In medico-legal practice, air embolism of the heart can be treated as an independent cause of death, for example, in the situation of isolated venous damage in the neck or pelvis. On the contrary, it is more common for air embolism of the heart to occur as one of several competing causes of death. In such cases, demonstrating the presence of air in the heart may help to answer the question of the time elapsed between injury and death. The objective of the study was to ascertain whether there was a statistically significant relationship between the presence of gas in the right heart cavities and other locations, taking into account whether the presence of gas could be attributed to posttraumatic or post-mortem changes, based on PMCT examination. The results of this research indicate that the presence of gas in following locations: the aorta arch, abdominal aorta, liver, kidneys and L3 vertebrae indicates the postmortem nature of the gas in the right heart cavities. On the contrary, the presence of gas in the cranial cavity, pulmonary arteries, left brachiocephalic vein and venous angles provide evidence in favor of the external nature of gas in the right heart cavities.