Images in 60-year old man who underwent bilateral lung transplant 2 months before death. He developed postoperative delirium and was treated for pneumonia. Just prior to death he developed hypotension and agonal breathing. There were signs of elevated jugular venous pressure. Resuscitation during asystole was unsuccessful. Patient died under clinical suspicion of central pulmonary embolus or cardiac tamponade. Conventional autopsy identified a possible myocardial infarction and thrombo-emboli as cause of death, whereas cause of death at minimally invasive autopsy was massive air embolus.