Olds Kelly, Gilbert John, Langlois Neil E I, Byard Roger W
School of Medicine, University of Notre Dame, Henry St, Perth, 6160.
Forensic Science SA, GPO Box 2790, Adelaide, 5001.
J Forensic Sci. 2019 Jul;64(4):1245-1247. doi: 10.1111/1556-4029.13970. Epub 2018 Dec 4.
A 32-year-old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe-patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.
一名32岁女性在静脉注射包含碾碎药片的物质后晕倒。尝试进行复苏但未成功。她有因静脉注射毒品导致并发症的广泛既往病史。死亡原因是混合药物中毒。尸检的主要发现包括右股静脉上方一个10毫米深的皮肤窦道，该窦道被用作注射部位。注射部位以及肺内存在可极化异物，并伴有肉芽肿反应。值得注意的是，一个卵圆孔未闭使得该物质反常栓塞进入体循环，并滞留于肝脏、肝门淋巴结、心肌、脾脏、肾脏和胰腺。该病例强调了对于前来进行法医学评估的静脉注射毒品者，检查任何可能非常小的心脏内分流以及异物向多个器官的全身播散的重要性。
