Sudden death by rupture of a varicose vein: a forensic analysis on a case report

The Institute of Forensic Medicine in Brescia received a request from the Judicial Authority to conduct an inspection at a residence where a deceased woman had been discovered. The body of the seventy-two-year-old was discovered lying face down on the bathroom floor, with a large pool of blood originating from the lower limbs. Near the body, several towels completely soaked in blood were found, as were the garments worn by the deceased. There were abundant traces of blood scattered throughout various rooms of the house, and these did not exhibit a pattern that could be uniquely interpreted. Even the external examination conducted at the scene did not provide clarifying elements, making it necessary to proceed with the autopsy. The body was transferred to the morgue at the Spedali Civili Hospital of Brescia, where a thorough external examination was conducted. No signs of external injury were found, except for a circular-shaped, raised, hyperchromic lesion on the right leg, approximately 0.8 cm in diameter. The central portion of the lesion extended to the subcutaneous layer and was still oozing blood. Given the unusual nature of the case, it was decided to perform a post-mortem CT scan in order to preliminarily assess any pathological substrates not detectable through external examination alone. The scan showed the absence of foreign bodies and the presence of widespread varicosities in the venous circulation of the right lower limb. The autopsy revealed no further significant pathological alterations, and a sample of the lesion described was subsequently collected for further analysis. From the microscopic evaluation, following Van Gieson trichrome staining, the presence of a discontinuous skin component was observed, adjacent to which there was a muscular component lacking smooth muscle, in which the venous vessel was partially occluded by thrombus-like material. Venous vessel pathologies are commonly found within the population, particularly in those over 50, and are especially more frequently observed in women from the post-menopausal period onwards. They predominantly affect the vessels of the lower limbs and are generally characterized by a clinically benign progression. In cases of difficult interpretation, such as the one presented, the crucial role of the forensic pathologist is evident, given their interdisciplinary expertise. Through the evaluation of all available evidence, the pathologist was able to determine the cause of death as a massive hemorrhage, secondary to the rupture of a varicose vein complication in the right lower limb. Therefore, although not listed among the most frequently encountered causes of death, it is crucial to recognize its potential developments in order to safeguard public health through awareness and the prevention of avoidable deaths.