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

## TL;DR

A young driver died from a severe heart injury after a car crash, despite having no visible chest wounds.

## Contribution

This case highlights the importance of internal examination in trauma-related deaths with no external chest injuries.

## Key findings

- Blunt cardiac rupture occurred without external chest trauma in a young driver after a car collision.
- Autopsy revealed a 2-cm right ventricular rupture and 400 cc of blood in the pericardial cavity.
- Pregabalin was detected in the toxicology report but not in lethal concentrations.

## 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.