Header

UZH-Logo

Maintenance Infos

Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application


Heimer, Jakob; Eggert, Sebastian; Fliss, Barbara; Meixner, Eva (2019). Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application. Forensic Science, Medicine, and Pathology, 15(2):239-242.

Abstract

We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient’s death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.

Abstract

We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient’s death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.

Statistics

Citations

Altmetrics

Downloads

0 downloads since deposited on 06 Jan 2020
0 downloads since 12 months

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Legal Medicine
Dewey Decimal Classification:340 Law
610 Medicine & health
510 Mathematics
Scopus Subject Areas:Health Sciences > Pathology and Forensic Medicine
Uncontrolled Keywords:Pathology and Forensic Medicine, General Medicine
Language:English
Date:1 June 2019
Deposited On:06 Jan 2020 16:09
Last Modified:22 Apr 2020 21:57
Publisher:Springer
ISSN:1547-769X
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s12024-019-00107-4
PubMed ID:30905038

Download

Closed Access: Download allowed only for UZH members