DOI: 10.36347/sjmcr.2018.v06i07.002

Pages: 446-448

A 75-year-old man called his care manager with his cell phone when he suddenly experienced hematemesis. Unfortunately, by the time that the care manager arrives at his house, the patient had already fallen unconscious. When emergency medical technicians (EMTs) reached him, he was in a state of cardiopulmonary arrest. A physician transported via helicopter treated him with tracheal intubation. Massive continuous blood from a tracheal tube was observed when he received chest compression. Advanced cardiac life support failed to obtain spontaneous circulation. A postmortem computed tomography (CT) pan scan immediately after ceasing resuscitation revealed systemic air embolism, air in the aorta and bilateral alveolar hemorrhaging. The cause of death was unstable circulation due to massive hemorrhaging from the aorta and air embolism, and respiratory failure due to bilateral alveolar hemorrhaging by aspiration. In the present case, the mechanism of the air in the aorta and carotid artery may have been the result of a massive hemorrhaging from the fistula, and the introduction of air by spontaneous and mechanical ventilation through the fistula between the aorta and pulmonary parenchyma. This unique case adds one more cause to the list of documented etiologies of air in the aorta.