Images in emergency medicine

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Diagnosis 

Activated charcoal aspiration. At autopsy, gross examination of his pulmonary tree revealed activated charcoal in his oropharynx, trachea, and pulmonary parenchyma, described as diffuse and focal black geographic discoloration of both lung fields, with airways containing black particulate matter (Figure 1, white arrow). Histologic slides revealed activated charcoal within bronchiole and in peribronchiolar alveolar spaces, with extensive polymorphonuclear leukocytic infiltration (Figures 2 and 3). Although much is written on indications for activated charcoal, timing of administration, and complications, death is rarely reported. This case illustrates the importance of patient selection for activated charcoal administration and the potentially fatal complications associated with its use.