LOS ANGELES - Michael Jackson's outward appearance was marred when he died with puncture marks to his arms, surgical scars around his body and cosmetic tattoos on his lips and scalp.
But internally, the pop star was in mostly fine physical shape for a 50-year-old man, according to his autopsy report obtained by The Associated Press.
The Los Angeles County coroner's report shows Jackson's weight of 136 pounds was in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque buildup. His kidneys and most other major organs were normal.
The singer did have health issues, however, including arthritis in the lower spine and some fingers, and mild plaque buildup in his leg arteries. Most serious was the condition of his lungs, which the autopsy report said were chronically inflamed and had reduced capacity that might have left him short of breath.
But the lung condition was not serious enough to be a direct or contributing cause of death, according to the document.
"His overall health was fine," said Dr. Zeev Kain, chairman of the anesthesiology department at the University of California, Irvine, who reviewed a copy of the autopsy report for the AP. "The results are within normal limits."
Kain, who was not involved in the autopsy, said most of the scars appeared to be from plastic surgery though others, like a scar on the knee, could have been from a medical procedure.
The medical examiner found numerous punctures on both arms and on a knee and ankle. The leg punctures could have been from intravenous therapies not described in the autopsy report, Kain said.
Jackson had several tattoos, all of them cosmetic, including dark tattoos in the areas of both eyebrows and under his eyes, and a pink tattoo around his lips.
The singer died at his rented Los Angeles mansion June 25 after his personal physician, Dr. Conrad Murray, administered the anesthetic propofol and two other sedatives to get the chronic insomniac to sleep, court documents state. Propofol, normally a surgical anesthetic used in operating rooms, acts as a respiratory depressant and requires constant monitoring.
Murray told police he left the room to use the bathroom and phone records show he also made calls for 47 minutes around the time Jackson encountered problems. When Murray realized Jackson was unresponsive, he began frantic efforts to revive him, but Jackson never regained consciousness and was declared dead at the University of California, Los Angeles Medical Center.
The coroner's office announced last month that Jackson's death was a homicide caused by "acute propofol intoxication," with the other sedatives listed as a contributing factor. They said the standard of care for administering propofol was not met and the recommended equipment for patient monitoring, precision dosing and resuscitation was missing.
Murray is the target of what Los Angeles police term a manslaughter investigation. The decision on criminal charges will come from the Los Angeles County district attorney's office. Murray has been interviewed twice by police.
Except for a brief video posted to YouTube, Murray has not spoken publicly since Jackson's death, and his lawyer Ed Chernoff did not immediately respond to requests for comment Thursday. In the video, Murray said: "I told the truth and I have faith the truth will prevail." Murray's attorney, Edward Chernoff, previously has said nothing Murray gave Jackson "should have" killed him.
Jackson was declared dead a little more than two hours after paramedics were called. Evidence of the desperate struggle to save the star were evident on his body. He had chest bruising and cracked ribs from CPR, and a mechanical device known as a balloon pump was inserted into his heart to try to restart it, according to the autopsy report.
Jackson's body was taken by helicopter to the coroner's office where the following morning Chief Medical Examiner Lakshmanan Sathyavagiswaran and Dr. Christopher Rogers carried out an extensive review and ordered a toxicology screening to look for drugs in his system.
Aside from propofol and the sedatives, the only substances found in his system were the local anesthetic, Lidocaine, sometimes used to numb injection sites and ephedrine, a commonly used resuscitation stimulant.
No other drugs legal or otherwise were detected, nor was any alcohol.
Kain said he was surprised that three other sedatives, known as benzodiazepines, were present with propofol. Anesthesiologists sometimes mix one "benzo" with propofol to help put a patient under, but using three increases the danger for the patient.
"People don't mix the benzodiazepines together because they interact with each other and increase the risk of respiratory arrest," Kain said, adding it was likely Jackson first stopped breathing and then suffered cardiac arrest.
Court records state Murray told police he administered 25 milligrams of propofol to Jackson. But that's a very small dose that would not have kept the star under for long, raising questions about whether Murray misspoke or police misinterpreted what he told them.
The autopsy report says the drug was detected in several samples taken from Jackson's system but does not provide an estimate of the dosage. Kain said it's difficult to calculate the dose based on the report's data because, among other things, the precise time Jackson died and stopped processing the drug is not known.
The autopsy findings cut off a potential defense for Murray that Jackson hid serious pre-existing conditions that increased the risk of death from the drugs he willingly took. Even if he did hide a condition such as his weakened lungs, a prosecutor could argue Murray should have detected the condition before administering drugs, said Michael Brennan, a clinical law professor at the University of Southern California who specializes in criminal defense.
"A doctor has some obligation to know what his patient's physical condition is," Brennan said. "The doctor is going to try to substantiate whatever the patient told him ... and not simply rely on a patient's descriptions of his physical condition."
At the time of his death Jackson was preparing for a series of comeback concerts in London. Rehearsals were rigorous and there were questions about whether Jackson would be physically able to hold up.
But aside from his lungs, the autopsy report did not identify any serious physical problems that might have limited Jackson's ability to perform. It also said he was actively producing sperm.
The report provided details about Jackson's state from head to toes.
He had a 3/4-inch scar behind his left ear and another apparent scar behind his right ear. He had a scar beside each of his nostrils and another, 4-inch scar on his right shoulder. He had a pair of additional scars about 3-inches long at the base of his neck and smaller scars on his arms and wrist. He also had a small scar near his navel and a 2-inch scar on the right-hand side of his abdomen.
He was going bald at the front of his head, with his remaining hair described as short and tightly curled. The bald part of his scalp was darkened with what appeared to be a tattoo stretching across the top of his head from ear to ear.
The coroner found depigmentation of his skin around his chest, abdomen, face and arms.
Los Angeles Police Department spokeswoman April Harding said the investigation was ongoing and she couldn't comment further.