Hemorrhage from a cavernous hemangioma with fatal blood aspiration: A rare cause of sudden unexpected death

Blood aspiration may be fatal, even when caused by a minor hemorrhage, and then it is important to localize and identify the source of bleeding in order to determine its origin as traumatic, spontaneous or iatrogenic. The present case deals with the clinically unexpected sudden death of a 73-year-old woman who underwent pulmonary artery catheterization (PAC) 11 days before because of known pulmonary hypertension. The forensic autopsy revealed a previously undiagnosed cavernous hemangioma of the right lung which had led to a local intrapulmonary hemorrhage with secondary bleeding into the bronchial tree. The fatal blood aspiration was preceded by recurrent episodes of hemoptysis, and its occurrence was probably promoted by the pre-existing pulmonary hypertension. The present case and other reports in the medical literature suggest that vessel malformations of the lung have to be considered as a potential cause of unexpected sudden death. Careful investigation is needed for post-mortem identification of the bleeding site.