Venous aneurysm leading to fatal pulmonary thromboembolism with a history of a remote stab wound of the extremity

Venous aneurysms are rare, and their incidence is unknown. External iliac vein aneurysms are even more rare with only 50 case reports published from 1950 to 2018. We present a case of an individual who died suddenly from a pulmonary thromboembolic event due to an external iliac vein aneurysm formed by a remote penetrating injury. A 32-year-old male was in Immigration and Customs Enforcement (ICE) custody when he died suddenly. It was discovered during his autopsy that he had an occlusive pulmonary thromboembolism (PE) within the left main pulmonary artery and distal branches of the right pulmonary artery. On additional investigation and postmortem computed tomography, a large saccular aneurysm arising from the external iliac vein was discovered. This aneurysm contained clotted blood, and was determined to be the cause of his PE and subsequent death. Although rarely a source for a fatal PE, venous aneurysms should be considered as a possible source for thromboembolism; their presence may alter the manner of death, given their underlying etiology. This is especially true for young adults with a remote history of trauma near a major venous tributary, as traumatic arteriovenous fistula is a common cause of secondary venous aneurysm. For this case, the manner of death was classified as homicide.