Cardiac tamponade due to massive hemopericardium caused by spontaneous rupture of a non-aneurysmatic coronary artery: A rare case report

Cardiac tamponade is a medical condition that occurs when there is an accumulation of blood, pus, fluid, or gas in the area around the heart (i.e. the pericardial cavity), leading to increased pressure within the pericardium. In forensic practice, sudden natural deaths are mostly related to cardiovascular conditions including cardiac tamponade. Owing to the sudden and rapid nature of its progression and fatal outcome, CT is often diagnosed during postmortem examination. In this case report, we discuss the sudden death of a 54-year-old male deceased due to a sudden collapse. No external or internal injuries were observed. On internal examination, in the mediastinum, a "Blue dome" sign of the heart was present; 600 g of liquid and clotted blood were present in the pericardial cavity. The etiology was not ventricular free wall rupture; rather, it was coronary artery rupture, which is a rare cause of such tamponade. Postmortem histopathology revealed significant atherosclerotic changes in the coronary arteries, leading to atherosclerotic plaque rupture. This etiology was first reported in this case, causing fatal cardiac tamponade.