Saturday, 7 July 2012

EMedinews:Insights on Medicolegal Issues:Postmortem examination in a case of pneumothorax

The occurrence of sudden death presents a challenge in legal autopsy
  • In cases of sudden death after pneumothorax, pneumoperitoneum, intravenous infusions, childbirth, operations, or sharp instrument injuries to the neck and thorax, it is important to check for air embolism to the heart.
  • A postmortem chest x–ray should be taken and inspected for larger quantities of air in the heart and great vessels.
  • Postmortem examination accuracy of observation, completeness of detail, and sound conclusions can be obtained only when the postmortem examination is made according to some definite and systematic plan so that regions and organs are successively examined without disturbing the relations and appearances yet to be investigated.
  • Chest radiographs provide the most reliable method for determining the extent of pneumothoraces and whether or not a pneumothorax has resulted in mediastinal shift.
  • Detection of a pneumothorax is easily done by holding the dissected skin and subcutaneous tissues of the chest to form a pocket adjacent to the ribcage in postmortem examination.
  • The pocket is filled with water, and a scalpel is used to incise the thoracic cavity. The presence of air bubbles indicates a pneumothorax.
  • In the cases of neonates and small infants during the autopsy, the thorax may be submerged in a bucket of water.
  • The apparatuses described previously for detection of air emboli work equally well for detecting pneumothoraces

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