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J. J. MOAR
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Pulmonary embolism following trauma is a well-recognized
event, .the embolus usually consisting of fat and haemopoietic
tissue or both. Occasional cases involving cerebral tissue emboliz-
ing to lung after trauma,' birth injury2-6 or a gunshot wound of
the brain 7 have also been reported. Pulmonary embolism due to
hepatic tissue, however, has generally been considered a rarity,
only 4 reports S- 11 having appeared in the English language
literarure during the period 1942-1971. Animal experiments 12 in
which liver lacerations were produced in dogs by closed blunt
abdominal trauma appeared to confIrm the rarity of the condition,
since no cases of pulmonary embolism by hepatic tissue were
observed among these animals.
The following case report describes a pulmonary embolism
due to hepatic tissue in a 25-year-old man who had fallen off a
train and who survived for 6 hours. This finding may be of use in
indicating the antemorrem nature of an injury, thus differen-
tiating it from a postmortem traumatic artefact.
Fig. 1. Section of lung tissue showing a tissue plug lying free within
a pulmonary vessel.
Case report
A 25-year-old Black man was admined to the casualty department
of Baragwanath Hospital, Johannesburg, after falling from a
train. Examination revealed an unconscious, areflexic patient
with no recordable· blood pressure, no spontaneous respiration
and numerous conrusions and lacerations over the right side of
the body and face. A maxillary fracture was present as well as a
ruptured liver. He was given 2 units of blood and intubated,
ventilated and resuscitated. In spite of these measures his
condition deteriorated rapidly, and he died 5 hours after
admission (6 hours after the accident).
At autopsy numerous conrusions and lacerations were noted
over the right side of the body as well as an extensive rupture of
the liver involving the right and left lobes including the caudate
and quadrate lobes. The peritoneal cavity contained 2600 ml of
blood. The spleen was undamaged. There were no further
fmdings of note on macroscopic examination.