- Pseudoaneurysm in injected drug abusers occurs due to traumatic damage by the repeated injections and infections. It most commonly involves the femoral artery that requires intensive management. When medical attention is delayed, the victim is prone to have massive bleeding from the ruptured artery, resulting in death. Although pseudoaneurysms in injected drug abusers are known, there is paucity of autopsy study on sudden deaths due to its rupture. We report four such cases with different presentations of the pseudoaneurysm that had ruptured spontaneously. The paper highlights the case history and autopsy findings of these cases with review of literature of this catastrophic event in injected drug abusers.