A soldier dies within an hour of a grenade explosion despite surviving the initial detonation. Autopsy shows pulmonary contusion with ruptured alveoli and intravascular air in the coronary and cerebral arteries. What is the immediate cause of death?
- A Exsanguination from bronchial artery rupture
- B Systemic arterial gas embolism arising from disrupted alveoli and pulmonary veins ✓
- C Asphyxia from bilateral haemothorax
- D Fat embolism from contused lung parenchyma
Correct answer: B. Systemic arterial gas embolism arising from disrupted alveoli and pulmonary veins
Explanation
Primary blast injury to the lung disrupts the alveolar-capillary interface. Air from ruptured alveoli can enter torn pulmonary veins and be carried to the systemic circulation, producing coronary and cerebral arterial air embolism, which causes rapid cardiac arrest or stroke. This is a recognised early cause of death in blast lung. Bronchial bleeding and haemothorax occur but are not the classic immediate mechanism, and fat embolism develops later and is not typical of blast lung.
Reference: Knight's Forensic Pathology, 4th ed.
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