Fatal Isolated Right Ventricular Rupture Without External Chest Injury in a Young Driver: Forensic Autopsy Findings After a One-Sided Vehicle Collision

Abstract

Traumatic deaths are common, with cardiac trauma affecting 7‒12% of patients with thoracic injuries. Blunt cardiac injury (BCI), although rare, is associated with a high mortality rate. This report presents a case of blunt cardiac rupture (BCR) observed at autopsy despite the absence of external chest trauma, suggesting the presence of severe internal injuries. A 19-year-old male was found dead in his vehicle which had collided with a wall. At the crime scene investigation, external examination revealed no substantial chest wall injuries in the individual despite significant damage to the vehicle. Autopsy revealed a 2-cm rupture of the right ventricle (heart), accompanied by 400 cc of partially coagulated blood in the pericardial cavity, consistent with cardiac tamponade. Pregabalin was detected in the toxicology analysis, but not in lethal concentrations. Traffic accidents are a major cause of BCI, typically resulting from compression of the heart between the thoracic structures during high-energy impacts. BCR is particularly fatal and often results in rapid death before arrival to the hospital. The absence of external trauma in the current case underscores the need for thorough internal examination in trauma-related deaths.

Keywords: Blunt cardiac injury, Forensic medicine, Trauma, Traumatic death, Vehicle collision