Fatal Hemorrhage Due to Rupture of a Pseudoaneurysm in an Arteriovenous Fistula in a Hemodialysis Patient: A Case Report

Fatal hemorrhage from vascular access is a rare but life-threatening complication in patients undergoing hemodialysis. Determining the cause and manner of unwitnessed death is challenging, highlighting the importance of forensic evaluation. A 62-year-old woman undergoing long-term hemodialysis was found dead in her bathroom. Scene investigation revealed extensive bright-red blood loss and multiple bloodstain patterns. External examination revealed a 5 cm oval-shaped bulging lesion at the arteriovenous fistula site on the left upper arm, consistent with a pseudoaneurysm. The overlying skin was thinned with whitish discoloration, and two focal dark reddish lesions at the center, one with a ruptured defect. No other significant injuries were found. Death was attributed to massive hemorrhage from arteriovenous fistula rupture. Based on scene findings and external examination, homicide and suicide were excluded; necrotic changes indicated progressive deterioration, confirming spontaneous rupture. This case demonstrates that pseudoaneurysm formation and skin changes in arteriovenous fistulas may lead to fatal hemorrhage. Careful evaluation of morphological features and scene findings is essential for determining the cause and manner of death in unwitnessed cases.