Death due to an unrecognized groin abscess in a drug addict: A retrospective study

D’Ovidio, Cristian; Vellante, Paola; Costantini, Sara; Carnevale, Aldo

doi:10.1016/j.jflm.2013.03.008

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…The pallor, faint hypostasis, and organ anemia were consistent with reports of massive external bleeding at the scene or documented signs of hypovolemic shock in those who received medical treatment. A similar presentation – massive bleeding at the groin injection site, but without pseudoaneurysm, was reported in case of infection‐related femoral artery erosion and in cases of femoral vein erosion 12, 16 …”

Section: Discussionsupporting

confidence: 57%

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Exsanguination from ruptured femoral artery pseudoaneurysm – A fatal complication of groin heroin injection

Leković

Živković

Nikolić

2022

Journal of Forensic Sciences

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Intravenous drug users (IDUs) eventually encounter a common problem-a need to turn to a new vessel to inject drugs. Whether it is because no other spot is available due to scarring or convenience, the groin is the preferred spot for some. Chronic puncture of femoral vessels can lead to a rare but significant complication-femoral artery pseudoaneurysm (FAP). Its fatal consequence-rupture and bleeding is well recognized, but the forensic literature on this subject is limited. We present eight cases of exsanguination due to the ruptured FAP in IDUs who share most or all the following characteristics: long-term heroin use and/or pronounced drug use stigmata, chronic groin injectionrelated lesions, absence of significant precipitating pseudoaneurysm trauma, and no or minimal concentrations of heroin metabolites in blood. The FAP presentation varied greatly, from palpable fist-sized mass or slight elevation under the skin defect to infundibular arterio-cutaneous fistula that ruptured through the skin induration. In some, surrounding skin or soft tissue showed signs of inflammation but without suppuration. The most prominent FAP characteristic was smooth-surface cavitation on cross-sections.We performed microscopic evaluation in two cases and verified disruption of the artery wall (i.e., pseudoaneurysm) with elements of acute and chronic inflammation and fibrosis; foci of fibrinoid necrosis were noticed on the arterial wall. All subjects were pale, with faint hypostasis and organ anemia, consistent with reported massive hemorrhage.Because such sudden, unwitnessed, and suspicious deaths may raise the question of injury infliction, proper autopsy evaluation is crucial, for which we propose guidelines.

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Section: Discussionsupporting

confidence: 57%

“…A similar presentation -massive bleeding at the groin injection site, but without pseudoaneurysm, was reported in case of infection-related femoral artery erosion and in cases of femoral vein erosion. 12,16 The rupture of femoral artery pseudoaneurysm due to groin drug injection is rarely encountered but might be underreported.…”

Section: Discussionmentioning

confidence: 99%

Exsanguination from ruptured femoral artery pseudoaneurysm – A fatal complication of groin heroin injection

Leković

Živković

Nikolić

2022

Journal of Forensic Sciences

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“…S. aureus is the most commonly reported pathogen, forming nearly 28% of all MPAs 4 9. Imaging modalities employed frequently involve ultrasound with venous and/or arterial Doppler, CT scan, MRI and arteriogram 3 7 10 11. Ultrasound with/without Doppler might not accurately define pathology and vessel compromise.…”

Section: Discussionmentioning

confidence: 99%

“…2 5 7 Graft placement is often complicated by graft infection and endovascular coiling increases the likelihood for necrosis and abscess formation 6. There is no role for conservative therapy without removal of the infective focus 7 10. Additionally, 4–8 weeks of antimicrobial therapy is advocated with de-escalation of therapy as per sensitivity patterns 5…”

Section: Discussionmentioning

confidence: 99%

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

et al. 2015

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SUMMARYPseudoaneurysms are vessel wall ruptures, that are often mistaken for deep vein thrombosis (DVT). A middle-aged man presented with right leg pain, swelling and erythema. His history was significant for persistent Staphylococcus aureus bacteraemia. Ultrasound revealed subacute DVT and laboratory parameters were suggestive of sepsis. He was started on intravenous heparin and antimicrobials. Owing to persistent anaemia despite blood transfusion, MRI of the right thigh was obtained. It revealed a 13×17 cm superficial femoral artery infected mycotic pseudoaneurysm (MPA) with a fresh haematoma. The patient underwent arterial ligation and extensive debridement. Intraoperative cultures revealed daptomycin-resistant vancomycin-intermediate S. aureus (VISA) and he was managed with 6 weeks of intravenous ceftaroline. MPAs are most common in the femoral artery and form <1% of aneurysms. Therapy involves surgical debridement and prolonged antimicrobials. VISA causing MPA is associated with worse outcomes. We report the first time use of ceftaroline in the management of a VISA MPA. BACKGROUND

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“…It is estimated that there are approximately 13.2 intravenous-drug addicts worldwide [1]. Morbidity and mortality are related to the effect of substances themselves and to the risks intrinsic in the practice [2]. In terms of vascular injury, the lower limbs are most commonly affected [3].…”

Section: Introductionmentioning

confidence: 99%

Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

Kobilica¹,

Flis²

2021

SCR

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Accidental intraarterial injection is a serious condition which can compromise the viability of the limb within hours. There are no evidence based guidelines suggesting the proper treatment protocol and there is no consensus about the ideal treatment for these events. We present a case where a mixture of benzodiazepine pills and street heroin was injected in right femoral artery. Patient arrived in hospital days after event. With intraarterial application of thrombolysis, vasodilators and heparin major amputation was avoided. It seems that in selected cases combined therapy with rtPA lysis and PGE1 intra-arterial infusion may prevent major limb amputation even in delayed presentation of acute leg ischaemia caused by inadvertent injection of drugs of abuse.

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Death due to an unrecognized groin abscess in a drug addict: A retrospective study

Cited by 5 publications

References 34 publications

Exsanguination from ruptured femoral artery pseudoaneurysm – A fatal complication of groin heroin injection

Exsanguination from ruptured femoral artery pseudoaneurysm – A fatal complication of groin heroin injection

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

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