Electrical injury of the neck and cardiac air embolism: a novel mechanism of death

Abstract

We report a case of air embolism in an industrial worker complicating a deep electrical injury in the neck. He was found dead in an upright position while his chest and head were resting on top of a live transformer. At autopsy, there were multiple electrical burns involving the face, neck, chest, and arms. There was a deep electrical burn associated with hemorrhage in the neck involving the skin, underlying subcutaneous tissue, strap muscles, and the thyroid gland. The internal examination showed a prominently bulging right atrium, which was filled with air and not blood. At autopsy, when the pericardium was filled with water and the right atrium opened, a large number of bubbles emerged. We concluded that death was due to air embolism complicating electrical damage to the neck veins. This case illustrates that acute complications of electrical burns rather than electrocution-related cardiac arrhythmia can be the mechanism of death in rare electricity-related deaths. It also reveals the difficulties encountered by the pathologist in determining the exact mechanism of death when there are competing mechanisms.