Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient
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CASE REPORT
Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient Rin Asao1 · Kazumasa Nishida1 · Hiromichi Goto1 · Yoshikazu Goto2 · Noriatsu Ichiba3 · Isao Ohsawa1 Received: 3 August 2019 / Accepted: 11 February 2020 © The Author(s) 2020
Abstract Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT. Keywords Gas gangrene · Postmortem imaging · Dialysis · Intravascular gas · Clostridia species
Introduction Gas gangrene is a necrotic infection of the soft tissue and muscles that progresses rapidly and it has high mortality rates. In approximately 80% of the cases, gas gangrene is caused by Clostridium perfringens which is a Gram-positive spore-forming bacillus commonly found in the soil and intestines of humans and animals [1, 2]. Deep penetrating injuries compromise the blood supply and create an anaerobic environment that is ideal for spore germination and bacterial proliferation [3]. Other predisposing conditions are bowel and biliary tract surgery, intramuscular injection, gynecologic procedure, and intrauterine fetal death [1]. Although the clinical course of Clostridia gas gangrene is fulminant, patients do not usually exhibit specific or severe symptoms
* Isao Ohsawa [email protected] 1
Department of Nephrology, Saiyu Soka Hospital, 1‑7‑22 Matsubara, Soka, Saitama, Japan
2
Department of Neurosurgery, Saiyu Soka Hospital, Soka, Japan
3
Department of Radiology, Otsu City Hospital, Otsu, Japan
at onset. In addition, early diagnosis of necrotizing infections may be confounded by other factors [1]. Crescendo pain is the most important clinical manifestation of such infections. However, because pain can be absent in patients receiving analgesic agents and those having diabetes-related neuropathy or altered mental status, patients sometimes die shortly before a definitive diagnosis is established [1]. Currently, postmortem imaging is sometimes used as an alternative to conventional
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