Skeletal muscle and fatty tissue in mixed pulmonary embolism associated with liposuction: An incidental autopsy finding

Nonthrombotic pulmonary embolism is an uncommon life-threatening complication following liposuction. We report a rare incidental autopsy finding associated with this procedure. A 43-year-old female who underwent liposuction presented with hypotension, respiratory distress, loss of consciousness and cardiorespiratory arrest during the intraoperative period. The patient died 2 h after admission to the emergency department. Autopsy reported a massive hemoperitoneum (2.2 L) secondary to liver perforation associated with liposuction as the cause of death. Pelvic, umbilical and lumbar peritoneal perforations were also observed. The histological study showed segments of the pulmonary arteries occluded by mixed emboli of skeletal muscle fibers coexisting with fatty tissue. We discuss the origin, pathophysiology and clinical manifestations of this new kind of mixed pulmonary embolism.