Penetrating Cardiac Injury from a Single Stab Wound: Autopsy Findings of a Lethal Left Ventricular Perforation

Abstract

Penetrating cardiac injuries are uncommon but carry a high mortality rate, particularly when involving the left ventricle. Survival is rare because of rapid blood loss or cardiac tamponade before medical intervention. This case describes the forensic examination of a 27-year-old man who sustained a single stab wound to the left anterior chest inflicted by an unknown assailant. External examination revealed pallor of the conjunctivae and an open wound on the left chest. Internal examination demonstrated blood infiltration of the left anterior thoracic wall extending to the fourth intercostal space. Approximately 1,000 mL of blood was present in the left pleural cavity and 250 mL within the pericardial sac. The stab wound penetrated the pericardium and left ventricle, causing fatal hemopericardium and cardiac tamponade. This case shows how a single deep chest wound can rapidly cause death and highlights the value of detailed autopsy in determining cause and manner of death.