Summary
At post-mortem examination the lungs of 30 intravenous narcotic addicts were compared to two groups of 30 age- and sex-matched controls with no history of narcotic abuse. A distinctly uneven distribution of pulmonary pathology among the two groups was found, with various non-acute, non-granulomatous lesions dominating in the addict group. Microscopically, the typical pattern consisted of focally thickened fibrotic and hypercellular alveolar septa, accumulation of haemosiderin-laden macrophages in alveolar walls as well as in the lumina of alveoli and respiratory passages, and vascular lesions with full-thickness fibrosis of arterial walls. An attempt at quantitative scoring of the changes indicated that the extent of pulmonary pathology increases with the addict's age or duration of narcotic abuse and with the degree of social deterioration. The same changes could also be demonstrated in some control cases with a history of salicylate or alcohol abuse, or with known heart/lung disease.
The addict group also exhibited myocardial alterations in 28 of 30 cases. Typical findings were myofibrillar degeneration and fatty infiltration.
In 15 of 30 addicts morphological and toxicological examination did not yield a definitive cause of death. However, the present demonstration of cardiopulmonary pathology suggests that narcotic addicts may be prone to acute circulatory and/or respiratory derangement even if no overdose of drugs is taken.
Similar content being viewed by others
References
Andersen R and Refstad S (1978) Adult respiratory distress syndrome precipitated by massive saticylate poisoning. Inten Care Med 4:211–213
Armed Forces Institute of Pathology (1969) Manual of histological and special staining technique. 2nd ed. McGraw-Hill Book Co., Inc, New York
Benowitz NL, Rosenberg I and Becker CE (1979) Cardiopulmonary catastrophies in drug overdosed patients. Med Clin North Am 63:267–296
Duberstein JL and Kaufman DM (1971) A clinical study of an epidemic of heroin intoxication and heroin-induced pulmonary edema. Am J Med 51:704–714
Frand UI, Shim CS and Williams MH (1972) Heroin-induced pulmonary edema. Ann Intern Med 77:29–35
Haft JI (1974) Cardiovascular injury induced by sympathetic catecholamines. Progr Cardiovasc Dis 17:73–86
Karliner JS, Steinberg AD and Williams MH (1969) Lung function after pulmonary edema associated with heroin overdose. Arch Intern Med 124:350–353
Katz S, Aberman A, Frand UI, Stein JM and Fulo M (1972) Heroin pulmonary edema. Evidence for increased pulmonary vascular permeability. Am Rev Respir Dis 106:472–474
Krasnoff SO and Bernstein M (1947) Acetylsalicylic acid poisoning. JAMA 135:712–714
Lewman LV (1972) Fatal pulmonary hypertension from intravenous injection of methylphenidate (Ritalin) tablets. Hum Pathol 3:67–70
Monforte JR (1977) Some observations concerning blood morphine concentrations in narcotic addicts. J Forens Sci 22:718–724
Murray JF (1974) Diffuse infiltrative diseases of the lung in Harrison's Principles of Internal Medicine, Seventh Edition, McGraw Hill Book Company, pp 1291-1298
Rajs J and Falconer B (1979) Cardiac lesions in intravenous drug addicts. Forens Sci Int 13:193–209
Rajs J, Högberg J, Härm T, Ormstad K, Edlund PO and Dahlström B (1980) The cause of sudden death in connection with intravenous administration of heroin. A preliminary forensic-pathologic and toxicologic study. Proceedings of The First Scandinavian Conference of Forensic Science. Linköping June 11–13. pp 59–63
Reichenbach DD and Benditt EP (1970) Catecholamines and cardiomyopathy: The pathogenesis and potential importance of myofibrillar degeneration. Hum Pathol 1:125–150
Siegel H (1972) Human pulmonary pathology associated with narcotic and other addictive drugs. Hum Pathol 3:55–66
Steinberg AD and Karliner JS (1968) The clinical spectrum of heroin pulmonary edema. Arch Intern Med 122:122–127
Tomashefski JF and Hirsch CS (1980) The pulmonary vascular lesions of intravenous drug abuse. Hum Pathol 11:133–145
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rajs, J., Härm, T. & Ormstad, K. Postmortem findings of pulmonary lesions of older datum in intravenous drug addicts. Vichows Archiv A Pathol Anat 402, 405–414 (1984). https://doi.org/10.1007/BF00734637
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00734637