Self-induced hemopericardium using a syringe needle: A rare method of suicide

This communication highlights a rare case of suicide by self-induced hemopericardium caused by a penetrating syringe needle. A 20-year-old male, diagnosed with ulcerative colitis, severe depression and hypochondriasis, was found dead at home. There was a 23-gauge 3 cm long syringe needle, connected to a 3 cc barrel, penetrating the left side of the chest. Autopsy revealed 3 fresh puncture marks on the left side of the anterior chest with subcutaneous hemorrhage underlying the puncture marks. The needle had penetrated through the 4th intercoastal space and entered the pericardial cavity causing superficial lacerations to the anterior wall of the heart. There were two anterior pericardial perforations. A hemopericardium of 235 ml was noted. Interventricular septal branches arising from the lower half of the left anterior descending artery were lacerated. Microscopy revealed multiple fresh hemorrhages into the myocardium at the site of myocardial injuries. Toxicological analysis of blood, urine and swabs from the syringe barrel was negative. The cause of death was given as hemopericardium due to laceration of the interventricular septal branches of the left anterior descending artery due to penetration by a 23-gauge syringe needle. The circumstance was concluded as suicidal. Suicide by stab to the chest using a 23-gauge syringe needle, resulting in hemopericardium where the source of blood was the coronary artery, has not been reported in the medical literature. A forensic pathologist must be vigilant and cautious in the interpretation of similar findings especially when cardiopulmonary resuscitation and/or therapeutic intracardiac injections have been administered.