Ruptured pseudo-aneurysm of a femoral artery in a drug abuser revealed by post-mortem CT angiography

Abstract

A 35-year-old drug addict was found dead in a public toilet with a ruptured groin, which was later diagnosed to be a leaking pseudo-aneurysm. Investigation at the scene revealed impressive external hemorrhage related to a groin wound. Post-mortem computed tomography angiography demonstrated an aneurysm of the right femoral artery with leak of contrast liquid. Signs of blood loss were evident at autopsy, and histological examination revealed necrosis and rupture of the pseudo-aneurysm. Toxicological analyses were positive for methadone, cocaine, citalopram, and benzodiazepines. This is the first case report in the literature of a ruptured femoral pseudo-aneurysm with a post-mortem radiological diagnosis.

Post-mortem computed tomography angiography using left ventricle cardiac puncture: A whole-body, angiographic approach

“…The combination of PMCT and PMCTA is time conserving and can provide three-dimensional images that enable clear visualization of deep and narrow blood vessels [ 5 , 11 , 13 , 14 ]. The combined approach has been applied, and has demonstrated its ability to detect vascular injuries and abnormities including cardiac and aortic injuries, intracranial arteriovenous malformation, and aneurysm [ 4 , 15 , 16 ]. This promising modality has been considered to be an effective supplement to autopsy or an alternative if autopsy is refused [ 11 , 17 ].…”

Apports et limites de l’imagerie en médecine légale du vivant dans le cadre d’une expertise pénale

“…Des études ont montré récemment l'apport de l'angioscanner pour des diagnostics en post-mortem [14]. Il peut permettre la localisation précise de lésions vasculaires à l'origine d'hémorragies mortelles, dans le cadre d'acte auto-agressif [10], de complication d'une toxicomanie intraveineuse [15] ou lorsqu'une origine iatrogène est suspectée : décès secondaire à une infection nosocomiale [16] ou postchirurgical [17]. L'angioscanner post-mortem peut être plus performant que les autopsies dans la détection d'une source d'hémorragie [18].…”

Exsanguination from ruptured femoral artery pseudoaneurysm – A fatal complication of groin heroin injection

“…Rupture of a pseudoaneurysm leads to abrupt massive bleeding. However, forensic literature on this topic is limited 4, 7, 8 . The aim of this study was to analyze the details of 8 deaths evaluated in our institution, in which a ruptured femoral artery pseudoaneurysm caused sudden death in a known intravenous drug user, and to propose suggested guidelines for evaluation of these deaths.…”

“…[Color figure can be viewed at wileyonlinelibrary.com] technique to evaluate the vessels is postmortem angiography. In addition to showing the vessel anatomy and rupture site, the imaging also demonstrate any retained needle fragments (reportedly present in up to 20% of IDUs), which can help minimizing risk of injury to autopsy personnel 8,14,19. The microscopic evaluation can confirm the pseudoaneurysm diagnosis; if available, additional histologic evaluation for bacteria and fungus could be considered to identify any underlying infectious organism.…”