Forensic Implications of Sternal Bone Marrow Biopsy Fatalities: Autopsy Case Report

Iatrogenic penetrating injuries of the thoracic aorta are rare. When surgical treatment is delayed or unavailable, they are associated with high mortality. Herein we present a case of a 36-year-old woman who had a sternal marrow biopsy performed due to laboratory-confirmed pancytopenia. Autopsy revealed 4 needle punctures extending through the full thickness of the upper right quarter of the sternum. Mediastinal soft tissue and the upper part of the pericardium were diffusely effused with blood. On the aortic arch, between the innominate artery and the left common carotid artery, we found a linear penetrating injury (2 mm in length). Autopsy revealed bilateral hemothoraces, the right hemothorax being generally larger than the left (2000 mL vs 50 mL of blood). In the presented case, the cause of death is considered to be exsanguination due to iatrogenic injury of the aorta during sternal bone marrow aspiration. Death occurring during or after medical procedures requires extremely careful postmortem evaluation.