Most cases of sudden unexpected 'natural' death are due to primary disorders of the cardiovascular, respiratory and central nervous system. Sudden death due to a previously undiagnosed malignancy is rare in young, apparently healthy subjects. We report an unusual cause of sudden unexpected death due to pulmonary tumour embolism complicating an undiagnosed germ cell tumour of the testis in a 37-year-old white male. Although death due to testicular tumours is not uncommon in young adult males, it rarely follows pulmonary embolism secondary to inferior vena cava (IVC) tumour invasion. A review of the literature revealed four other cases with a similar mechanism of death.