Well, you would have heard it here first but my TV died,
literally died right before they showed the autopsy reports. Here is the actual
autopsy report (courtesy of TMZ.com)
Anna Nicole Smith died of an accidental drug overdose with
traces of nine prescription drugs in her blood, including anti-depressants and
officials said on Monday. There was no evidence of illegal drugs in her body,
said Broward County Medical Examiner Joshua Perper, who gave a detailed account
of the events leading up to her death that included her temperature at various
times and the medication she took.
Perper said Smith suffered severe depression after the death
of her 20-year-old son, Daniel, who died of a drug overdose in the Bahamas
hospital after Dannielynn was born.
Nine prescription drugs including anti-depressants,
anti-anxiety drugs and the sedative chloral hydrate were found in Anna Nicole's
blood, Perper said.
COUNTY MEDICAL EXAMINER
5301 SW 31st AVENUE
Vickie Lynn Marshall AUTOPSY
OF AUTOPSY: February 9, 2007
OF AUTOPSY: 10:36 a.m.
Gertrude M. Juste, M.D.
Associate Medical Examiner
Joshua A. Perper, M.D.
Chief Medical Examiner
ACUTE COMBINED DRUG INTOXICATION
(TCE) 75ug/mL (active metabolite)
acid ( TCA) 85ug/mL (inactive metabolite)
Therapeutic drugs :
Diphenhydramine (Bendaryl) 0.11 mg/L
Clonazepam (Klonopin) 0.04 mg/L
Diazepam (Valium) 0.21 mg/L
Nordiazepam (metabolite) 0.38 mg/L
Temazepam (metabolite) 0.09 mg/L
Oxazepam 0.09 mg/L
Lorazepam 22.0 ng/mL
Other non-contributory drugs present (atropine, topiramate, ciprofloxacin,
LEFT GLUTEAL PANNICULITIS, WITH ABSCESS FORMATION AND
FIBROSIS WITH FAT NECROSIS (CHRONIC REPEATED INJECTIONS OF
MEDICATIONS IN BUTTOCKS) OF DERMAL AND
TISSUES, BILATERAL GLUTEAL REGIONS AND
GASTROENTERITIS, MILD, OF PROBABLE VIRAL ETIOLOGY
DEPRESSION FOLLOWING RECENT DELIVERY OF TERM INFANT AND
DEATH OF ADULT SON (SEPTEMBER 2006)
Lynn Marshall February 9, 2007 10:36 a.m. 07-0223
MODERATE CONGESTIVE HEPATOMEGALY (2550 GRAMS)
FIBROUS PLEURAL ADHESIONS
CHRONIC THYROIDITIS (HASHIMOTO THYROIDITIS)
WELL HEALED SUPRAPUBIC SCAR (STATUS POST CESAREAN
MINIMAL, INSIGNIFICANT MYOCARDIAL FIBROSIS
STATUS POST MEDICAL INTERVENTION
Endotracheal tube placement
Right jugular line placement
Cardiac Monitoring devices and defibrillator pad placement
Bilateral anterior elbow and left anterior wrist venipuncture sites with
STATUS POST BILATERAL *** IMPLANTS WITH SCARRING, LEFT
MICRO-INFARCT OF BRAIN, LEFT OCCIPITAL WHITE MATTER
MINOR CONTUSIONS, POSTERIOR SHOULDERS
Lynn Marshall was a 39-year-old white female who died of acute combined drug
Abscesses of buttocks, and viral enteritis were contributory causes of death.
manner of death is determined to be: ACCIDENT
PRESENT AT AUTOPSY:
A. Perper, M.D.,LL.B.,M.Sc., Chief Medical Examiner; Gertrude M. Juste, M.D., Associate
Medical Examiner; Predrag Bulich, M.D., Assistant Medical Examiner; Harold Schueler,
Phd., Chief Toxicologist; Stephen J. Cina, M.D., Deputy Chief Medical Examiner;
Joseph Anderson, Forensic Photographer; James Fleurimond, Forensic
Photographer; Irma Motem, Forensic Technician; Dean Reynolds, Morgue
Supervisor; Reinhard W. Motte, M.D., Associate Medical Examiner; Detective Rich
Engels of the Broward Sheriff’s Office, Crime Scene Unit; Chief Tiger of the
Seminole Police Department and Deputy Mike Jacobs of the Seminole Police
body is clad in a light green hospital gown, which is intact, dry and clean.
There is no jewelry present.
body is that of a well-developed, well-nourished white woman appearing the
offered age of 39 years. The body measures 71 inches and weighs 178 pounds.
unembalmed body is well preserved and cool to touch due to refrigeration. Rigor
mortis is fully developed in the major muscle groups. Livor mortis is fixed and
purple posteriorly except over pressure points. However, during initial examination
in the emergency room, there was no rigor and lividity was at a minimum and
unfixed. The skin is intact and shows no evidence of trauma except for medical
intervention. The scalp hair is blond and measures up to 5 inches in length in
the frontal area and up to 19 inches in length in the back and on top of the
head. There are multiple blonde hair extensions including several pink strands
attached to the natural hair, which shows light brown roots. The irides are
hazel and the pupils are equal, each measuring 0.5 centimeter in diameter. The
corneae are clear and the sclerae and conjunctivae are free of petechiae. The
nasal bones are intact by palpation. The nares are patent and contain no
foreign matter. There is a 3-millimeter raised nodule on the right side of the
nose. The natural teeth are in good condition. The frenula are intact. The oral
mucosa and tongue are free of injuries. The external ears have no injuries.
There are bilateral earlobe piercings; no earring or jewelry were present.
There are no earlobe creases.
neck is symmetrical and shows no masses or injuries. The trachea is in the
midline. The shoulders are symmetrical and are free of scars.
chest is symmetrical and shows no evidence of injury. There were bilateral
breasts with asymmetry of the left *** due to scarring. The flat abdomen has
no injuries. There are piercings above and below the umbilicus. The back is
symmetrical. The buttocks have inconspicuous small scars, bilaterally. There is
a flat, round scar on the lower aspect of the left buttock approximately ½ inch
genitalia are those of a normally developed adult woman. There is no evidence
anus is unremarkable.
upper extremities are symmetrical and have no injuries. The fingernails are
long and clean. There is a linear ½ inch scar on the anterior right forearm.
Two parallel linear scars measuring 1 inch and 2 inches are on the anterior
surface of the left forearm.
lower extremities are symmetrical. The toenails are short and clean. There is
no edema of the legs or ankles.
is no abnormal motion of the neck, the shoulders, the elbows, the wrists, the
fingers, the hips and ankles. There is no bony crepitus or cutaneous crepitus
dissection of the posterior neck and upper back show a 2-¼ x 2-¾ inch reddish,
recent contusion of the subcutaneous and superficial muscle layer of the left
posterior shoulder. A recent, reddish, 1-¾ x 1-½ inch reddish contusion is
present on the right posterior shoulder involving the superficial muscular
OF RECENT MEDICAL TREATMENT:
properly positioned size 8 endotracheal tube retained by a Thomas clamp is
present at the mouth with the marker 22 at the anterior teeth. Electrocardiogram
pads are on the anterior chest in the following order: two on the right
anterior shoulder, two on the left anterior shoulder, one on the upper anterior
left arm, one each on the anterior side, one each on the anterior leg.
defibrillator pads are present: one to the right of the midline, above the
right ***, and one to the left of the midline, below the left ***.
is intravenous line placement at the right anterior neck with hemorrhage into
the anterior strap muscles of the neck. One recent needle puncture mark is in
the right antecubital fossa and two recent needle puncture marks are at the
anterior left elbow with surrounding ecchymoses. There is one recent needle
puncture into the medial one-third of the left anterior forearm with surrounding
ecchymosis. A recent needle puncture mark is at the left anterior wrist with surrounding
reddish ecchymosis, 1 inch in diameter.
are multiple scars and tattoos on the body.
x ½ inch flat scar is on the upper inner
aspect of the right *** quadrant. A ½ x 3/8-inch scar is on the medial
aspect of the left nipple. There are circular scars adjacent to both areolae.
The right inframammary skin has a linear transverse . inch remote “chest tube”
scar. There were bilateral inframammary and transverse linear 3-¾ inch scars
compatible with left and right mammoplasty with *** implants. There are
circular scars surrounding piercings above and below the umbilicus. A flat 3/8
inch in diameter scar is present on the middle third of the anterior surface of
the right thigh. Lateral to this scar is a ½ inch in diameter flat scar. There
are several scattered small inconspicuous scars on both buttocks. There is a
cluster of multiple, parallel, linear, well-healed scars on the anterior and
lateral aspects of the right leg covered by a tattoo.
is a pair of red lips in the right lower abdominal quadrant.
red cherries are on the right mid pelvis.
Bunny” is on the left anterior mid pelvis.
words “Daniel” and “Papas” are on the mid anterior pelvis region.
mixed tattoo on the right lower leg and ankle represents: Christ’s head; Our
Lady of Guadalupe; the Holy Bible; the naked torso of a woman; the smiling face
of Marilyn Monroe; a cross; a heart and shooting flames.
mermaid on a flower bed with a pair of lips underneath it laying across the
body was opened with the usual Y incision. The *** tissues, when incised,
revealed bilateral implants, each containing 700ml of clear fluid. The implants
were surrounded by a thick connective tissue capsule with a thick yellow fluid.
The content of each capsule was collected for bacteriological cultures.
muscles of the chest and abdominal wall are normal in color and consistency.
The lungs are neither hyperinflated nor atelectatic when the pleural cavities
are opened. The right lung shows adherence to the parietal pleura and to the
diaphragm interiorly. The ribs, sternum and spine exhibit no fractures. The
right and left pleural cavities have no free fluid. There are extensive right
pleural fibrous adhesions. The mediastinum is in the midline. The pericardial
sac has a normal amount of clear yellow fluid. The diaphragm has no
abnormality. The subcutaneous abdominal fat measures 3 centimeters in thickness
at the umbilicus. The abdominal cavity is lined with glistening serosa and has
no collections of free fluid. The organs are normally situated. The mesentery
and omentum are unremarkable.
soft tissues and the strap muscles of the neck, aside from the previously
described focal hemorrhages, exhibit no abnormalities. The hyoid bone and the
cartilages of the larynx and thyroid are intact and show no evidence of injury.
The larynx and trachea are lined by smooth pink-tan mucosa, are patent and
contain no foreign matter. There is a focal area of reddish hyperemia at the
carina associated with the endotracheal tube. The epiglottis and vocal cords
are unremarkable. The cervical vertebral column is intact. The carotid arteries
and jugular veins are unremarkable.
heart and great vessels contain dark red liquid blood and little postmortem
clots. The heart weighs 305 grams. The epicardial surface has a normal amount
of glistening, yellow adipose tissue. The coronary arteries are free of
atherosclerosis. The cut surfaces of the brown myocardium show no evidence of
hemorrhage or necrosis.
pulmonary trunk and arteries are opened in situ and there is no evidence of
thromboemboli. The intimal surface of the aorta is smooth with a few scattered
yellow atheromata. The ostia of the major branches are of normal distribution
and dimension. The inferior vena cava and tributaries have no antemortem clots
(See attached cardiopathology report for additional details).
lungs weigh 550 grams and 500 grams, right and left, respectively. There is a
small amount of subpleural anthracotic pigment within all the lobes. The
pleural surfaces are free of exudates; right-sided pleural adhesions have been
described above. The trachea and bronchi have smooth tan epithelium. The cut
surfaces of the lungs are red-pink and have mild edema. The lung parenchyma is
of the usual consistency and shows no evidence of neoplasm, consolidation, thromboemboli,
fibrosis or calcification.
liver weighs 2550 grams. The liver edge is somewhat blunted. The capsule is
intact. The cut surfaces are red-brown and of normal consistency. There are no
focal lesions. The gallbladder contains 15 milliliters of dark green bile.
There are no stones. The mucosa is unremarkable. The large bile ducts are
patent and non-dilated.
thymus is not identified. The spleen weighs 310 grams. The capsule is shiny,
smooth and intact. The cut surfaces are firm and moderately congested. The
lymphoid tissue in the spleen is within a normal range. The lymph nodes
throughout the body are not enlarged.
tongue shows a small focus of submucosal hemorrhage near the tip. The esophagus
is empty and the mucosa is unremarkable. The stomach contains an estimated 30
milliliters of thick sanguinous fluid. The gastric mucosa shows no evidence or
ulceration. There is a mild flattening of the rugal pattern within the antrum
with intense hyperemia. The duodenum contains bile-stained thick tan fluid. The
jejunum, ileum, and the colon contain yellowish fluid with a thick, cloudy,
particulate matter. There is no major alteration to internal and external inspection
and palpation except for a yellowish/white shiny discoloration of the mucosa.
The vermiform appendix is identified. The pancreas is tan, lobulated and shows
no neoplasia, calcification or hemorrhage.
are no intraluminal masses or pseudomenbrane.
kidneys are of similar size and shape and weigh 160 grams and 190 grams, right
and left, respectively. The capsules are intact and strip with ease. The
cortical surfaces are purplish, congested and mildly granular. The cut surfaces
reveal a well-defined corticomedullary junction. There are no structural
abnormalities of the medullae, calyces or pelves. The ureters are slender and
patent. The urinary bladder has approximately 0.5 milliliters of cloudy yellow
urine. The mucosa is unremarkable.
vagina is normally wrinkled and contains no foreign matter. The uterus shows a
reddish endometrial lining with no evidence of intra-uterine pregnancy. The
fallopian tubes and ovaries are within normal limits.
adrenal glands have a normal configuration with the golden yellow cortices well
demarcated from the underlying medullae and there is no evidence of hemorrhage.
The thyroid gland is mildly fibrotic and has focally pale gray parenchyma on
sectioning. The pituitary gland is within normal limits.
radiographs of the body show no acute, healed or healing fractures of the head,
the neck, the appendicular skeleton or the axial skeleton. The muscles are
normally formed. Dissection of the right anterior thigh in the aforementioned
areas of scarring revealed subcutaneous fibrosis and multiple small cysts
containing turbid, yellow fluid. The cyst-like structures range in sizes from
0.5 centimeters to 1.2 centimeters in diameter. The cyst associated with the
most medial scar is 8 millimeter in diameter and has a calcified wall and the
cyst associated with the more lateral scar measures 1 centimeter in diameter. Vickie
Lynn Marshall February 9, 2007 10:36 a.m. 07-0223 Dissection of the buttocks
reveals diffuse subcutaneous scarring and fat necrosis of the adipose tissue
bilaterally with three subcutaneous cystic structures containing light yellow,
clear, thick liquid within the left buttock. The right buttock contains similar
cysts with similar content, with at least one cyst wall being calcified. The
left and right buttocks have foci of recent, hemorrhagic tracts within the
subcutaneous adipose tissue and the superficial and deep muscular layers
extending from the skin surface. There is a deep-seated 3 x 2.5 x 2 centimeter
abscess within the musculature of the left buttock with a creamy, yellow-green
pus on sectioning. A recent, hemorrhagic, needle tract extends into the abscess
wall from the skin surface.
scalp has no hemorrhage or contusions. The calvarium is intact. There is no
epidural, subdural or subarachnoid hemorrhage. The brain has a normal
convolutional pattern and weighs 1300 grams. The meninges are clear. The
cortical surfaces of the brain have mild to moderate flattening of the gyri
with narrowing of the sulci. The brain is cut after formalin fixation and a
separate neuropathology report is attached.
by layer anterior and posterior neck dissections were conducted. Dissection of
the entire back including both gluteal regions was conducted. A biological trace
evidence was collected. Multiple hairs were pulled from various parts of the
head. The nails of the left hand were cut and preserved. Additional blood and
tissue samples for DNA was collected.