Cardiopulmonary resuscitation-related renal vein and multivisceral organ injuries: a rare forensic autopsy case

Cardiopulmonary resuscitation (CPR) is a vital life-saving intervention but may result in various traumatic injuries, particularly with vigorous or prolonged efforts. Although visceral injuries are uncommon, they can be fatal. In this report, we present a rare postmortem case demonstrating multiple internal injuries-including pericardial and myocardial lacerations, liver laceration, and renal pelvis and renal vein injury-following CPR. A 70-year-old male was found unresponsive on the roadside and transported to the emergency department, where CPR was initiated due to cardiac arrest. Despite all medical interventions, resuscitation efforts were unsuccessful. Laboratory tests showed elevated cardiac and liver enzymes. A forensic autopsy was performed due to the suspicious nature of the death. External examination revealed no signs of assault; a burn over the sternum was consistent with defibrillator pad contact. CPR-related rib and sternal fractures were observed. A non-transmural myocardial laceration with pericardial injury was noted. Minor intraperitoneal hemorrhage, small hepatic and renal lacerations, and a millimetric tear in the left renal vein were identified. Histopathology revealed severe coronary atherosclerosis with ~80% luminal narrowing. Toxicology detected only therapeutic drug levels. The patient had a history of hypertension without recent cardiac follow-up. Surveillance footage showed the individual clutching his chest before collapsing. In conclusion, this case underscores that multiple internal organ injuries, although uncommon, may arise as complications of CPR. In elderly individuals, reduced tissue resilience may predispose to pericardial, myocardial, hepatic, and renal venous injuries, which should be considered in both clinical management and forensic evaluations.