CASE REPORT

Accidental Fatal Lung Injury by Compressed Air

A Case Report
Anand Parashuram Rayamane, MD, PGDMLE, PGDHR* and Pradeepkumar MV, MD

Abstract: Compressed air is being used extensively as a source of

energy at industries and in daily life. A variety of fatal injuries are caused
by improper and ignorant use of compressed air equipments. Many
types of injuries due to compressed air are reported in the literature
such as colorectal injury, orbital injury, surgical emphysema, and so on.
Most of these injuries are accidental in nature. It is documented that
40 pounds per square inch pressure causes fatal injuries to the ear, eyes,
lungs, stomach, and intestine. Openings of body are vulnerable to injuries by compressed air. Death due to compressed air injuries is rarely
reported. Many cases are treated successfully by conservative or surgical
management. Extensive survey of literature revealed no reports of fatal
injury to the upper respiratory tract and lungs caused by compressed air.
Here, we are reporting a fatal event of accidental death after insertion of
compressed air pipe into the mouth. The postmortem findings are corroborated with the history and discussed in detail.
Key Words: compressed air, lung injury, autopsy
(Am J Forensic Med Pathol 2015;36: 1Y2)

ompressed air has been used in the industry and daily living
for variety of purposes such as inflating tires, operating air
power tools and paint guns, and so on. However, ignorant and improper use of compressed air equipment leads to disastrous fatal
events. Colorectal injuries and orbital injuries are among the rarely
reported injuries due to compressed air. Subcutaneous emphysema
is also seen in a few cases when the air enters a damaged skin. Death
due to compressed air injuries is rarely reported as many cases are
treated successfully by conservative or surgical management.
Technical search found that 40 pounds of air pressure released from the nozzle of an air gun passing 4 inches from the
ear can cause rupture of the ear drum and/or cerebral hemorrhage resulting in death. The same pressure passing this distance from the eyes or mouth can cause blindness or rupture of
the lungs, stomach, or intestines. It has been estimated that only
4 pounds of direct air pressure will rupture the bowel.1 Here, we
are reporting an autopsy case of accidental death after insertion
of compressed air pipe into the mouth.

CASE REPORT
History of the Case
The deceased, a 29-year-old young man, on the fateful day
after finishing the bore-well work, was cleaning dirt on his clothes
Manuscript received April 7, 2014; accepted June 9, 2014.
From the *Department of Forensic Medicine, Mysore Medical College and
Research Institute, Mysore, Karnataka, India; and RajaRajeswari
Medical College and Hospital Bangalore, Karnataka, India.
The authors report no conflicts of interest.
Reprints: Anand Parashuram Rayamane, MD, PGDMLE, PGDHR, Department
of Forensic Medicine, Mysore Medical College and Research Institute,
Mysore, Karnataka 570001, India. E-mail: anandprayamane@gmail.com.
Copyright * 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0195-7910/15/3601Y0001
DOI: 10.1097/PAF.0000000000000109

Am J Forensic Med Pathol

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Volume 36, Number 1, March 2015

with the air pipe when, accidentally, the pipe was brought very
close to the mouth. Suddenly, he collapsed and died on the spot.
The said pipe is the small air pipe fitted adjacent to the main air
pipe, which is used to release the pressure from the main air pipe
of the bore well. Investigation revealed that the air pressure in
small pipe is between 100 and 200 pounds per square inch.

Postmortem Findings
The deceased was moderately nourished. External appearances were unremarkable. No external injuries were noted over
the body. On dissection, the mucosal surfaces of the larynx,
trachea, and bronchi were denuded mucosa, congested and
stained with grayish material (Fig. 1). The right lung weighed
500 g, and the left lung weighed 400 g. Lungs were firm,
edematous, and congested. Cut section showed reddish granular
appearance with multiple areas of hemorrhage. Other viscera
showed no significant findings. Both lungs and trachea were
subjected for histopathological examination.

Microscopic Findings
The trachea showed denudation of the respiratory mucosa
and congested blood vessels with foci of hemorrhage. Patchy
anthracotic pigmentation was present. Both lungs showed areas
of alveolar damage with diffuse hemorrhage and edema. Alveolar capillaries showed extensive congestion and anthracotic
pigmentation perivascularly as well as in the alveolar interstitial
region and alveoli (Fig. 2). Section from hila showed hemorrhage in the bronchial lumen with congestion and hemorrhage
in the bronchial wall (Fig. 3).

Cause of Death
On the basis of investigative information, postmortem findings, and histopathological examination, the cause of death was
opined as respiratory failure due to diffuse alveolar damage.

DISCUSSION
A compressed air injury is generally an accidental industrial mishap and occurs rarely because of a prank or practical
jokes or playing with the dangerous compressed air pipe for
fun.2 Compressed airYrelated injuries rarely results in death of
the person, as most of the cases are caused by mild impact with
the pressured pipe, which is effectively treated. Most reported
cases are due to the air hose being held at a distance from the
anus for fun and the air is forced into the anus through the
clothes causing colorectal injuries. These minor injuries were
treated successfully by means of conservative or surgical
treatment.2Y6 In cases of compressed air injury, air accumulates
in the body cavities with minimal tissue inflammation.7 In cases
of compressed air jet injuries through the anus, death is caused
by any of the following mechanisms: acute air embolism, acute
fat embolism, acute respiratory insufficiency due to enhanced
intra-abdominal pressure and chest compression, or acute heart
failure due to insufficient preload and peritoneal shock.8
Kampmann and Kijewski9 reported a case of compressed air
inserted into the anus causing multiple perforations of the large
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Am J Forensic Med Pathol

Rayamane and MV

FIGURE 1. In situ dissection of the upper airway tract showing

grayish congested denuded tracheal mucosa.

intestine, resulting in death. In their experimental work, they

showed that clothing does offer protection against the high-pressure
air and colon perforations are caused only if the distance between
the anal opening and the tip of the air pipe is very close.
In another case, a 7-year-old girl sustained accidental injury after injection of pressurized air from the air pipe used to
fill air into bicycle tire. She presented with generalized subcutaneous emphysema along with pneumomediastinum, pneumothorax, pneumoperitoneum, pneumoretroperitoneum, and
pneumorrhachis.10 Literature search also revealed a case of
distal esophageal rupture due to compressed air11 and many
cases of orbital injuries caused by compressed air.12Y15 In our
case, an ignorant act of the deceased to clean his shirt with ease
after a heavy work through the forced air from the air pipe led to
fatal injury to the respiratory tract causing death. Injury to the
upper respiratory tract or upper gastrointestinal tract is rare as
compressed air itself push face backward avoiding injuries
through oral or nasal orifice. As per history given by fellow
workers, the deceased kept the air pipe into his mouth, which
led to fatal lung injury causing instantaneous death. Compressed air pipe pressure was between 100 and 200 pounds per
square inch, which is 10 times greater than fatal pressure required to cause injury to the lungs.

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Volume 36, Number 1, March 2015

FIGURE 3. Hematoxylin-and-eosinYstained low-power view of

the bronchial wall showing hemorrhage into the bronchial lumen
and congestion and hemorrhage in the bronchial wall.

CONCLUSIONS
Compressed air injuries are rarely encountered by autopsy
surgeon; thorough autopsy with ancillary investigation helps to
conclude the cause of death. Educate the employees regarding
personal safety measures to be taken during the handling of
compressed air equipments.
REFERENCES
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compressed air. Int J Legal Med. 2011;125(2):283Y287.
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13. Hitchings R, McGill JI. Compressed air injury of the eye. Br J
Ophthalmol. 1970;54:634Y635.

FIGURE 2. Hematoxylin-and-eosinYstained low-power view of

the lung showing diffuse alveolar damage with alveolar hemorrhage,
edema, and congestion.

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14. Yuksel M, Yuksel KZ, Ozdemir G, et al. Bilateral orbital emphysema

and pneumocephalus as a result of accidental compressed air exposure.
Emerg Radiol. 2007;13:195Y198.
15. Caesar R, Gajus M, Davies R. Compressed air injury of the orbit in the
absence of external trauma. Eye. 2003;17:661Y662.

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