Ruptured palmar pseudoaneurysm after carpal tunnel surgery

Rupture of a pseudoaneurysm of the superficial palmar arch after surgical release of the carpal tunnel is an extremely rare and still debated occurrence. Only a few cases have been described in the literature, none of which were fatal. In this report, we present a single case that came to our attention, in which an elderly man suffered a fatal haemorrhage due to the rupture of a palmar pseudoaneurysm 22 days after surgical carpal tunnel release. Autopsy examination confirmed the presence of a breach in the large palmar hematoma as the sole source of bleeding. Histologic examination in some of the serial sections of the suprafascial hematoma revealed a ruptured arterial pseudoaneurysmal cavity. Based on these findings, the man's death could be attributed to acute haemorrhage due to the rupture of the palmar pseudoaneurysm. Further studies are required to investigate whether there is actually a causal link with the surgical release of the carpal tunnel but the current evidence suggest that this may be possible. The case is therefore reported to the forensic scientific community due to its exceptional occurrence and its potential implications.