This document summarizes different types of embolism including their causes, mechanisms, clinical features, and autopsy findings. It discusses pulmonary thromboembolism, systemic thromboembolism, fat embolism, air embolism, and amniotic fluid embolism. For each type, it outlines predisposing factors, the path through which emboli travel in the body, signs and symptoms, relevant laboratory tests, and how to identify evidence of embolism during autopsy. The document provides a comprehensive overview of embolism classification and characteristics.

1. DR.S.SYLVIA
DEPT. OF FORENSIC MEDICINE
2ND YEAR POST GRADUATE
KILPAUK MEDICAL COLLEGE
CHENNAI
EMBOLISM

2. EMBOLISM
 AN EMBOLISM IS A DETACHED
INTRAVASCULAR SOLID , LIQUID OR
GASEOUS MASS THAT IS CARRIED BY
THE BLOOD TO A SITE DISTANT FROM ITS
POINT OF ORIGIN.
 TERM- RUDOLF VIRCHOW ( FROM
POLAND)

3. CLASSIFICATION
 ACCORDING TO COMPOSITION
-- VENOUS
-- ARTERIAL
 ACCORDING TO CONTENT
-- THROMBO EMBOLISM
-- FAT EMBOLISM
-- AIR EMBOLISM
-- AMNIOTIC FLUID EMBOLISM
-- BRAIN, LIVER, BM,TUMOUR,BULLETS AND
PELLETS.

4. THROMBOEMBOLISM
PULMONARY
SYSTEMIC

5. https://www.youtube.com/watch?v=A
BTvNR59K5Q

6. PULMONARY THROMBO
EMBOLISM
 PREDISPOSING FACTORS:
1. AGE
2. GENERAL DEBILITY
3. IMMOBILITY / BED REST
4. INCRAESE CLOTTING TIME ( 2 WEEKS
AFTER INJURY)
5. LOCAL DAMAGE CAUSING INJURY TO
VEINS
6. BULLET OR STAB INJURY
7. 10-20% OF EMBOLI WITHOUT TRAUMA

8. PROCESS

9. https://www.youtube.com/watch?v=t
MrCwtzcVbU

10. PULMONARY VASCULATURE
MAIN
TRUNK
VAGAL INHIBITION
ACUTE DILATION OF
RIGHT HEART
COR PULMONALE
DEATH
BIFURCATION SMALL
VESSELS
BRONCHO
PULMONARY
SEGMENTS
INFRACTIO
N
HYPOXIA
GENERALISED
VASOSPASM
SUDDEN DECREACE BP
RT VENTRICLE OVER
DISTENSION
PERIPHERAL
HYPOTENSION/
INTERFERENCE OF
CORONARY FLOW
SYSTEMIC SHOCK

11. SADDLE EMBOLI

12. ON DISSECTION

14. DVT

15. SYSTEMIC THROMBO
EMBOLISM
 80% INTRA CARDIAC MURAL THROMBI
 2/3RD LEFT VENTRICULAR WALL INFRACTS
 1/4TH LEFT ATRIAL DILATION AND FIBRILLATION
 REST- AORTIC ANEURYSM, THROMBI ULCERATED
ATHEROSCLEROTIC PLAQUES OR FRAGMENTATION
OF A VALVULAR VEGETATION.
 SITE OF ARREST – 75% LOWER EXTREMITIES
10% BRAIN

17. PARADOXICAL EMBOLISM
EMBOLI
THROUGH THE INTER SEPTAL WALL
DEFECT
SYSTEMIC CIRCULATION

18. FAT EMBOLISM
 CAUSES
1. LONG BONES FRACTURE
2. ADIPOSE TISSUE INJURY( LIQUID FAT INTO
BLOOD VESSELS)
3. OIL INTO CIRCULATION ( CRIMMINAL
ABORTION- OIL OF SALVIN)
4. DIABETIS
5. LIPOSUCTION, OSTEOMYLITIS, SEPTICEMIA
6. SEVERE ANTEMORTEM BURNS
7. IV INJECTION OF OIL BASED DRUG

19. * FAT DROPLETS IN BLOOD -
INJURY WAS ANTEMORTEM
* 20- 100 ML OF FREE FAT
REQUIRED FOR EMBOLIC
DEATH

20. ORIGIN OF EMBOLI
 MECHANICAL THEORY
DESTROYS FAT CELLS AND LIBERATES
LIQUID FAT
TEAR OF VEINS
PRESSURE ON LIQUEFIED FAT DUE TO
MUSCULAR SPASM AND SWELLING

21. PHYSICO CHEMICAL THEORY
TRAUMA
ALTERATION OF THE NORMAL
PLASMA COLLOIDAL DISPERSION
FUSION OF CHYLOMICRONS
LARGE FAT DROPLETS
FAT EMBOLISM

22. FAT EMBOLI
TO PULMONARY VESSELS
OBSTRUCT BLOOD FLOW TO LUNGS
CYANOSIS/ PRECORDIAL PAIN/ INCREASE – PULSE,
RESPIRATION RATE, TEMPERATURE / PETECHIAL
HAEMORRHAGE
8-10HRS IMPACTION OF FAT INTO SMALL
BLOOD VESSELS
ABOUT 24- 30HRS AFTER TRAUMA- DEATH WITH
SEVERE DYSPNEA

23. CLINICAL FEATURES
 FEVER
 THROMBOCYTOPENIA
 TACHYCARDIA
 INCREASE RR
 FAT GLOBULES IN URINE AND SPUTUM
 CLUSTERS OF PETECHIAL HAEMORRHAGE SEEN IN
SKIN OF CHEST, NECK, SHOULDER
 FROZEN SECTION (SUDAN III)- FAT GLOBULES IN
PULM VESSELS
 LUNGS – CONGESTION / OEDEMA / HYPOSTATIC
PNEUMONIA

24. CEREBRAL FAT EMBOLISM
 AUTOPSY
 PETECHIAL HAEMORRHAGES IN WHITE MATTER
(CEREBRAL/ CEREBELLAR/ BRAINSTEM)
Ring OF
RBC
ARTERIOLE
WITH FAT
EMBOLI
NECROTIC BRAIN TISSU

25. AIR EMBOLISM
 CAUSES
INCISED WOUND OF LOWER CERVICAL / CLAVICULAR
REGION (JUGULAR/SUBCLAVIAN VEINS)
WOUND OF SAGGITAL SINUS INSIDE SKULL
IV INJECTION
CRUSH INJURY TO CHEST
POSITIVE PRESSURE VENTILATION IN NEWBORN
CRIMMINAL ABORTION – INJECTING AIR / FLUID
MIXED WITH AIR.
LSCS- EXTRACTION OF PLANCENTA
FALLOPIANTUBE- PATENCY TEST
SCUBA DRIVING ( DECOMPRESSION SICKNESS)

26. FACTORS FAVOURING
PULMONARY AIR EMBOLISM IN
INJURIES
 FIXATION OF WALLS OF VEINS (PELVIC, CLAVICULAR,
DURAL)
VESSELS CUT  NOT COLLAPSE  HAEMORRHAGE
 NEGATIVE PRESSURE AIR ENTERS THE VESSELS.
 SUCTION EFFECT OF RESPIRATION/ HEART 
EFFECT ON VEINS  NEGATIVE PRESSURE

27. AIR
VENOUS SYSTEM
RIGHT HEART
PULMONARY ARTERY
OBSTRUCTION
CHURNING OF AIR AND BLOOD
FROTH / AIR BUBBLES
FIBRIN DEPOSITE
PLATELET AGGREGATION
FURTHER OCCLUDING
DEATH

28. 100 ML OF AIR UNDER
PRESSURE
DEATH  DELAYED AUTOPSY
AIR DISSIPATES AND
DISSOLVES INTO TISSUE

29. DIAGNOSIS
 WHOLE BODY X-RAY
 RETINAL ARTERY- OPHTHALMOSCOPE

30. IN AUTOPSY
NOT TO OPEN STERNOCLAVICULAR JOINT (AIR WILLSUCK INTO VESSELS)
OPEN AT MANIBRIUM
CLAMP 1) ASCENDING AORTA, 2) VENA CAVA TO PREVENT AIR ESCAPE.
FILL CHEST CAVITY WITH WATER
CORONARY ARTERY INCISED AND MASSAGED
OBSERVE GAS BUBBLE ESCAPE

31. OPEN
PERICAEDIA
L SAC
FILL PERICARDIAL
SAC WITH WATER
PIERCE THE
RIGHT
VENTRICLE
WITH A INJECTION
CONTAINING 50ML
OF WATER AND
LARGE BORE
NEEDLE
AIR WILL
BUBBLE
UP
CO2 < 15%
N >70%
O2 < 8-15%
IN DECOMPOSITION
GAS

32. AIR FROM HEART
CONTACT WITH
ALKALINE
PYROGALLOL
IN PRESENCE OF
OXYGEN
TURNS BROWN
AIR EMBOLISM -
ANTE MORTEM

33.  EPICARDIAL VEINS BEADED APPEARANCE
WITH NUMEROUS AIR BUBBLE
 RIGHT VENTRICLE  DISTENDED WITH AIR
UNDER PRESSURE
 BRIGHT FROTHY BLOOD IN RIFGHT SIDE
HEART, VENA CAVA, PULM VEINS, CORONARY
VEINS
 FLUID BLOOD
 VISCERA CONGESTED
 PETECHIAE IN SEROUS SURFACE AND WHITE
OTHER POST MORTEM
CHANGES

34. SYSTEMIC EMBOLISM
INTERNAL CAROTID / BASILAR ARTERY
LIGATED BEFORE REMOVING BRAIN.
SKULL VAULT REMOVED WITHOUT DAMAGING
THE MENINGES
EXAMINE MENINGEAL VESSELS FOR VISIBLE
AIR BUBBLES
SUBMERGE BRAIN IN WATER
RELEASE LIGATURE AND CUT VESSELS
WATCH FOR AIR BUBBLES

35. AIR BUBBLE IN PIAL VEINS IS A
ARTEFACT

36. AMNIOTIC FLUID EMBOLISM
 MORTALITY 80%
 CAUSES
PELVIC TRAUMA OF PARTURITION ( UTERUS
RUPTURE)
1ST AND 2ND TRIMESTER ABORTION
ABDOMINAL TRAUMA
AMNIOCENTESIS
INSTRUMENTAL INTERFERENCE IN LATE
PREGNANCY  OPENING OF SINUS IN PLACENTAL
BED  ESCAPE OF AMNIOTIC FLUID.

37. AMNIOTIC FLUID
MATERNAL VENOUS CIRCULATION
PULMONARY MICROVASCULAR OBSTRUCTION
SEVERE TRANSIENT VASOSPASM OF PV
PULMONARY HT
RHF
BRONCHO-CONSTRICTION
HYPOXIA
DEATH

38. LAB INVESTIGATIONS
 DECREASE FIBRINOGEN
 INCREASE  FIBRIN, PARTIAL
THROMBOPLASTIN TIME
 THROMBOCYTOPENIA

39. HISTO PATHOLOGY
 MUCIN
 FOETAL SQUMOUS CELLS
 MECONIUM
 LANUGO HAIR
 VERNIX
 FAT GLOBULES

40. CAUSE OF DEATH
 IMMEDIATE- DIC
 ALLERGIC RESPONSE TO AF  COLLAPSE

41. MLI
 TRAUMA ( CHEST INJURY)
 MEDICAL NEGLIGENCE
 CRIMMINAL ABORTION

42. THANK U