Case ReportsThe Differential Diagnosis Between Natural Death and Homicide, an Everlasting Challenge for the Forensic Pathologist An Exemplar Case Reportdi Luca, Alessandro MD; de Matteis, Valentino MD; Marcelli, Antonio MD; Polacco, Matteo MD; Pascali, Vincenzo L. MD, PhD; Oliva, Antonio MD, PhDAuthor Information From the Section of Legal Medicine, Institute of Public Health, Catholic University School of Medicine, Rome, Italy. Manuscript received March 16, 2016; accepted October 10, 2016. The authors report no conflict of interest. Reprints: Alessandro di Luca, MD, Section of Legal Medicine, Institute of Public Health, Catholic University School of Medicine, Largo F. Vito 1, 00168, Rome, Italy. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: March 2017 - Volume 38 - Issue 1 - p 14-17 doi: 10.1097/PAF.0000000000000282 Buy Metrics Abstract Most of the work performed by the forensic expert is to find proof for different plausible hypotheses that may be used in a trial to serve justice purposes when the “identity” of a case is already unveiled. Yet the previous phase of the investigation is also of great importance, and sometimes (like in the presented case), it represents the core element of the entire investigation. The appropriate determination of the differential diagnosis between a natural death and a death of forensic interest (ie, homicide) is the first and crucial step in the classification of a case. This article analyzes the case of the body of a man found lying on the border of a country road with his wrists tied up with rope and the resulting investigation performed by the medicolegal forensic expert. In the end, as more specific examinations where performed aimed to find the truth, the final conclusions excluded a violent death and confirmed that the cause of the death was an acute myocardial infarction. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.