Air Embolism in a Case of Pulmonary Aspergillosis—A Case Report With Brief Review of Literature

Air embolism is a life-threatening condition characterized by the entry of air into the vessels, causing circulatory collapse. Air embolism may be arterial or venous, with venous air embolism being the most common. Arterial air embolism is commonly due to trauma or right to left shunting of cardiac circulation in cases of patent foramen ovale, ventricular septal defects, or rarely due to pulmonary arteriovenous fistulas. We report a case of a 40-year-old male who was diagnosed with pulmonary aspergillosis and sarcoidosis. He presented to the hospital with acute hemoptysis, where he deteriorated and was declared dead within 40 minutes. Postmortem computed tomography revealed air emboli in the coronary and cerebral vessels and the left ventricle. The possibility of decomposition gases was ruled out radiologically by grading the location and quantity of the air column. Thus, the case was diagnosed as spontaneous air embolism as a complication of pulmonary aspergillosis. The pathomechanism involved the formation of a broncho-vascular fistula due to expanding pulmonary cavitary lesions. Thus, in cases with acute hemoptysis complicating cavitary lung lesions, the treating physician should also suspect arterial air emboli, which can contribute to circulatory collapse in addition to aspiration of blood. Forensic pathologists are advised to employ postmortem computed tomography as a supplement to traditional autopsy while investigating deaths due to cavitary lung disease and hemoptysis.