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Sudden deaths due to accidental intravenous injection of perfluorocarbon during MRI cranial examinations

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Abstract

Unexpected deaths of three patients happened at a magnetic resonance imaging (MRI) clinic during cranial examinations with gadolinium-based contrast media. A toxicological screening using liquid chromatography–tandem mass spectrometry (LC–MS–MS) and gas chromatography–mass spectrometry (GC–MS) for blood and urine samples collected during autopsy of the cases resulted negative. During the police investigation, it was learned that a special brand of perfluorocarbon (FC-770) had been in use at the radiological clinic for prostatic, genitals, and external soft tissue examinations, and could supposedly be available in the room where the cranial MRI examinations were performed. Histologically the lungs of the three victims showed alveolar edema associated with pulmonary venous air embolism. Using a target LC–MS–MS method, gadolinium-based contrast agents Gd-DTPA and Gd-DOTA were detected in blood samples and results showed lower levels of Gd-DTPA and Gd-DOTA when compared with literature data for that kind of MRI examinations. Free gadolinium (Gd3+) was also determined by inductively coupled plasma–mass spectrometry in blood samples showing also low levels. Perfluorocarbon FC-770 was determined in blood by headspace–GC–MS. Results showed the presence of 19.3, 20.9, and 20.0 μg/ml of FC-770 in blood of the three victims, estimating an injected dose of at least 230, 180, and 180 mg/kg, respectively. The smallest fatal dose established in an early experimental study was estimated to be 6.8 mg/kg. The investigations concluded that mistakenly intravenous injection of FC-770 led to the deaths of the three victims by a mechanism of pulmonary venous gas embolism secondary to the presence of non absorbable and high vapor pressure FC-770 in the pulmonary capillaries.

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Acknowledgments

We thank all the institutions and technical staff that contributed to the development of this investigation, especially the Criminalistic Institute of São Paulo, the Campinas Municipal Health Department, the Institute of Chemistry from the State University of Campinas, the Toxicology Laboratory of Feevale University, Novo Hamburgo, the Institute Adolfo Lutz from São Paulo, and the Laboratório de Toxicologia e Essencialidade de Metais, Faculdade de Ciências Farmacêuticas, from the University of São Paulo, Ribeirão Preto. We convey special thanks to the police officers who headed the police investigation: Dr. José Carlos Fernandes, Dr. Antonio Carlos Palmieri, and Dr. Cibeli Sanches, from the State of São Paulo Police Department.

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest.

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Authors and Affiliations

  1. Campinas Poison Control Center, State University of Campinas, School of Medicine, Campinas, SP, Brazil

    Rafael Lanaro, Eduardo Mello De Capitani, José Luiz Costa & Fábio Bucaretchi

  2. Superintendência da Polícia Técnico Científica, Núcleo de Exames de Entorpecentes, São Paulo, Brazil

    José Luiz Costa

  3. Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil

    Loraine Togni

  4. Faculdade de Ciências Farmacêuticas, Universidade Feevale, Novo Hamburgo, Brazil

    Rafael Linden

  5. Laboratório de Toxicologia e Essencialidade de Metais, FCFRP, USP, Ribeirão Preto, Brazil

    Fernando Barbosa Jr.

  6. Laboratório Thonson de Espectrometria de Massas, Instituto de Química Unicamp, Campinas, Brazil

    Elias Paulo Tessaro, Giovana Anceski Bataglion & Marcos Nogueira Eberlin

  7. Superintendência da Polícia Técnico-Científica, Instituto Médico Legal de Campinas, Campinas, Brazil

    José Eduardo Bueno Zappa, Luis César Almeida & João Roberto Miller

  8. Departamento de Vigilância em Saúde, Vigilância Sanitária de Campinas, Campinas, Brazil

    Brigina Kemp

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  1. Rafael Lanaro
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  2. Eduardo Mello De Capitani
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  14. João Roberto Miller
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Corresponding author

Correspondence to Eduardo Mello De Capitani.

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Lanaro, R., De Capitani, E.M., Costa, J.L. et al. Sudden deaths due to accidental intravenous injection of perfluorocarbon during MRI cranial examinations. Forensic Toxicol 32, 323–330 (2014). https://doi.org/10.1007/s11419-014-0231-z

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  • DOI: https://doi.org/10.1007/s11419-014-0231-z

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