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Case Report of Fatal Complication in Prostatic Cryotherapy: First Reported Death Due to Argon Gas Emboli

Sandomirsky, Marianna MD*; Crifasi, Joseph A. MA*; Long, Christopher PhD*; Mitchell, Erik K. MD

The American Journal of Forensic Medicine and Pathology: March 2012 - Volume 33 - Issue 1 - p 68–72
doi: 10.1097/PAF.0b013e3181dd5b8c
Case Reports

We present the first reported fatality from argon gas emboli during prostate cryosurgery. The decedent underwent cryotherapy for prostate carcinoma using cryoablation probes which were cooled with argon and nitrous oxide and warmed with helium. Minutes into the procedure he experienced sudden cardiovascular collapse and could not be resuscitated. Postmortem examination was performed at the request of family and healthcare providers. Collection of tissues and blood samples had to be conducted carefully to capture suspected noble gases, argon, and helium. Specimens were submitted to Saint Louis University Forensic Toxicology Laboratory for toxicological examination and for evaluation of the composition of the gas retrieved from the vascular system. Gas chromatography mass spectrometric analyses confirmed argon in blood, brain, liver, and gas retrieved from the aorta. These samples had significant argon compared with room air also sent for comparison. The manner of death was accident. To date, there have been no intraoperative surgical fatalities reported from prostatic cryotherapy. We report such an unfortunate death to raise awareness in the medical community. We also describe how to collect and handle blood and tissue samples to submit for toxicological analysis in cases of volatile gas emboli.

From the *Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO; and †Frontier Forensics PA, Topeka, KS.

Manuscript received November 12, 2009; accepted December 23, 2009.

Presented at the NAME 2009 Annual Meeting, San Francisco, CA.

The authors report no conflicts of interest.

Correspondence: Joseph A. Crifasi, MA, St. Louis University Toxicology Laboratory. 6039 Helen Avenue, St. Louis, MO 63134.

© 2012 Lippincott Williams & Wilkins, Inc.