Nikolić Slobodan, Ječmenica Dragan, Živković Vladimir
Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska str., 11000, Belgrade, Serbia.
Forensic Sci Med Pathol. 2022 Jun;18(2):209-213. doi: 10.1007/s12024-022-00472-7. Epub 2022 Mar 9.
A 47-year-old woman with a long-term history of intravenous heroin use was found dead lying on the couch in a pool of blood with the wound in her right groin, 15 × 4 mm in diameter. The autopsy revealed the thickened superficial right femoral artery wall and the tract communication between the artery lumen and the skin surface, with pseudoaneurysm formation, confirmed by microscopic examination. Toxicological findings were negative for heroin and its metabolites. The cause of death was fatal blood loss from ruptured chronic femoral pseudoaneurysm. Persons with a long-term history of intravenous drug use experience injection-related problems: prominent vein scarring, lumps, and swelling. The risk of injecting the groin is substantially greater than in typical areas such as the cubital fossa. The proximity of the femoral vein to the femoral artery and nerve poses the risk of accidental trauma to these sites. Accidental groin arterial injections can cause a tear in the arterial wall, on which a pseudoaneurysm can develop. A false or pseudoaneurysm is a breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space. In the presented case, the autopsy findings pointed out that the fatal blood loss from femoral pseudoaneurysm rupture occurred probably after trivial trauma (shortly after sexual intercourse) or even spontaneously, and not immediately or shortly after arterial drug injection.
一名有长期静脉注射海洛因史的47岁女性被发现死在沙发上，躺在血泊中，右腹股沟有一个直径15×4毫米的伤口。尸检显示右股浅动脉壁增厚，动脉腔与皮肤表面有通道相通，形成假性动脉瘤，经显微镜检查证实。毒理学检查结果显示海洛因及其代谢物呈阴性。死因是慢性股部假性动脉瘤破裂导致的致命失血。有长期静脉吸毒史的人会经历与注射相关的问题：明显的静脉瘢痕、肿块和肿胀。在腹股沟注射的风险远高于肘窝等典型部位。股静脉与股动脉和神经相邻，存在意外损伤这些部位的风险。意外的腹股沟动脉注射会导致动脉壁撕裂，进而形成假性动脉瘤。假性动脉瘤是血管壁的破裂，导致血管外血肿与血管内空间自由相通。在本病例中，尸检结果表明股部假性动脉瘤破裂导致的致命失血可能发生在轻微创伤后（性交后不久），甚至是自发发生的，而不是在动脉注射毒品后立即或不久后发生。
