PULMONARY HISTOPATHOLOGY AND SURVIVAL PERIOD IN MORPHINE-INVOLVED DEATHS

For an evaluation of the survival period in morphine-involved deaths, changes of pulmonary histopathology were investigated in a total of 90 morphine-associated fatalities. Although pulmonary histopathology pro ved to be heterogeneous, several distinctive histological patterns eme rged. While the subgroup with short courses of intoxication (<1 h, n = 15) was mostly characterized by slight/moderate alveolar edema (12/15 ), severe hemorrhages (12/15) and marked acute emphysema (9/15), the p henomena of massive edema (8/15), missing/slight hemorrhages (8/15) an d absent/slight emphysema (11/15) dominated in the group with intermed iate survival times (1-24 h, n = 15). Intravascular leukocyte accumula tions (shock equivalents) occurred in the first group only once, but i n the group with the longer survival time in 10 of 15 cases. Delayed d eaths (>24 h, n = 4) were mainly characterized by purulent bronchitis/ pneumonia. Those fatalities (n = 56) that could not be classified by a namnestic data were assessed by histological criteria. In comparison w ith the evaluation of the survival period by toxicological analyses, c oncordance was found in 46 cases. Pulmonary histopathology is not a to ol for an exact graduation of survival time, but the combination of se veral key parameters can provide criteria for a differentiation betwee n short (<1 h) and longer courses of intoxication.