diagnostic dilemma with interval death in a road-traffic accident victim

background : the cause of death is difficult to interpret in a road-traffic accident (rta) victim, because multiple injuries make it difficult to decide on the most fatal lesion, particularly when death is delayed by prompt medical intervention; and secondary haemorrhage, renal failure, fat embolism, systemic infections, myocardial or cerebral infarction – all comes under the potential differential threats. case report: a 20 year-old rta victim was hospitalized in a comatose state and died after surviving 21 days on intermittent positive pressure ventilation. post-mortem examination of different organs revealed pneumonic consolidation in lung, fatty changes in liver and acute tubular necrosis in kidney; in addition to haemorrhage and congestion in these organs and brain. conclusion: acute contusions of various internal organs, compounded by hospital-acquired infection and medical interventions turn the overall diagnostic scenario messy in a resuscitated rta victim. in such condition notification about all lethal organic defects, instead of mentioning mere ‘multiorgan failure’, is the best way to sign out an ‘autopsy report.