Cardiac contusion and hemopericardium in the absence of external thoracic trauma: case report and review of the literature.

The case of an unusual homicidal cardiac contusion is described. A previously healthy 24-year-old woman suddenly died after being kicked on the chest by her boyfriend. A forensic autopsy was performed showing no external sign of thoracic trauma. An hemopericardium and a cardiac contusion of the basal and posterior surface of the left ventricle were found to be the cause of the death. Death could be a direct consequence of the myocardial contusion through electrical instability or/and consequence of the hemopericardium because its volume and sudden apparition were sufficient to cause tamponade. Numerous associated recent skin contusions mainly located on the face were consistent with inflicted blunt force trauma, supporting homicide as a manner of death. This case report underlines the importance of a systematic complete autopsy in all cases of sudden death occurring in a young adults, to rule out a possible homicide. The present case also shows that myocardial injury must be ruled out in every living patient presenting blunt chest trauma even in the absence of external sign.