Fatal Rupture of Brachial Pseudoaneurysm in a Drug Abuser

Abstract

The injection of drugs of abuse causes many millions of deaths each year; deaths are mostly due to fatal overdose and the trauma and infection caused by repeated injections. The scientific literature widely reports cases of infected pseudoaneurysm in injecting drug abusers; however, most of these autopsy cases deal with the rupture of pseudoaneurysm of the femoral artery. We present fatal hemorrhagic shock in a heroin-cocaine abuser subsequent to rupture of pseudoaneurysm of the brachial artery; the man collapsed just before injecting himself with a dose of heroin-cocaine (speedball).

Groin hit death due to femoral vein rupture in a drug abuser

“…4 The femoral vein is a common site for injecting IV drug by drug abusers, however after repeated injections the veins become sclerosed and the IV drug abuser then tends to inject drugs in the arteries, which result in the formation of pseudoaneurysm. 8 In the present case, the femoral artery was intact; however, the source of bleeding was identified as the femoral vein during the autopsy, which is a rare source of fatal hemorrhage especially in IV drug abusers, because repeated injection usually results in sclerosis of the veins which will further stiffen the venous wall. 8 If undetected in time, Vascular complication can result in rupture of such vessels with subsequent profuse bleeding and death, as has happened in this case.…”

“…7 Among the vascular complications, cases of fatal hemorrhages are mostly due to rupture of pseudoaneurysm of the femoral artery 7 and rarely due to pseudoaneurysm of the brachial artery. 8 Pseudoaneurysm is formed due to repeated trauma to the arterial wall resulting in disruption and hematoma formation, which is contained by surrounding tissue. 4 The femoral vein is a common site for injecting IV drug by drug abusers, however after repeated injections the veins become sclerosed and the IV drug abuser then tends to inject drugs in the arteries, which result in the formation of pseudoaneurysm.…”

The needle and the damage done: musculoskeletal and vascular complications associated with injected drug use

“…Vascular complications are common in PWID, can occur locally at the injection site or at a distant location and may be arterial or venous in nature. They occur more frequently when injected drug users progress from injection of superficial upper limb veins to larger and deeper vessels such as the femoral vein in the groin or jugular vein in the neck [ 15 , 26 ]. Vascular complications may manifest as injury to the vessel wall, interruption of blood flow in the lumen with resultant ischaemia or haematogenous spread of a pathogen from the injection site.…”

“…Arterial complications result from inadvertent and often repeated arterial puncture during attempted venous access and can lead to acute vascular emergencies. Arterial pseudoaneurysms occur as a result of direct disruption of the vessel wall at the injection site leading to the formation of an extravascular haematoma within the surrounding tissues which retains communication with the lumen of the artery [ 26 ]. Continued communication with the high-pressure artery results in gradual expansion of the pseudoaneurysm and increasing risk of rupture.…”

“…In PWID, pseudoaneurysms are frequently associated with surrounding soft tissue infection due to repeated non-sterile injection. This further increases the risk of rupture and bleeding which can be limb- or life-threatening [ 26 , 27 ]. The femoral artery in the groin is the most commonly affected vessel in PWID [ 27 ].…”