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Cysts in the lungs cost bodybuilder his life

A 29-year-old Greek bodybuilder died after cysts filled with blood burst open in his lungs. Researchers at the University of Ioannina describe the case in the journal Forensic Science International. Pulmonary peliosis is a rare disease, but the kind that the bodybuilder died of is unique, according to the researchers.

Bodybuilders familiar with the case of Andreas Muenzer know what peliosis hepatis is: blood filled cysts in the liver, which in Muenzer's case burst open and led to his death. The Greeks discovered a similar syndrome in the young bodybuilder, who was found dead in his home. His body had no external wounds, but when the researchers performed an autopsy, they were faced with a scene of unprecedented destruction.

The cavity of the man's left lung was full of blood, which had come from a couple of large cysts in his lung. These had burst open and the internal bleeding led to the bodybuilder’s death. The photo below shows the burst cysts.

Cysts in the lungs cost bodybuilder his life

The bodybuilder had an enlarged heart: his left ventricle was larger than normal. An enlarged left ventricle is sometimes seen in strength athletes that use steroids.

When the researchers performed a urine analysis they got confirmation that the bodybuilder had been using steroids. They found nandrolone and metabolites of this substance. The T/E ratio – the proportion of testosterone to epitestosterone – of the bodybuilder was 35.

The researchers did not go into whether the man used other substances as well: they only tested the dead man for a handful of commonly used anabolic steroids.

So far there have only been three cases reported of pulmonary peliosis in the medical literature, including that of the Greek bodybuilder. One of the other two cases also involved a steroids user: a 40-year-old man with a form of anaemia that doctors usually treat with oxymetholone.

In the other two cases, however, the patients had cysts in other places. The Greek is the first case in which the doctors encountered cysts in the lungs only – and nowhere else.

We don't know exactly how peliosis in the lungs arises. One theory is that something goes wrong in the cells of the blood vessels, which leads to the formation of blood sacs. This theory might explain why heavy steroids users sometimes develop peliosis. A lot has been written about the negative effects of androgens on the blood vessels.

Forensic Sci Int. 2009 Feb 23. [Epub ahead of print].

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