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Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy


Winklhofer, Sebastian; Surer, Eddie; Ampanozi, Garyfalia; Ruder, Thomas; Stolzmann, Paul; Elliott, Marina; Oestreich, Andrea; Kraemer, Thomas; Thali, Michael; Alkadhi, Hatem; Schweitzer, Wolf (2014). Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy. European Radiology, 24(6):1276-1282.

Abstract

OBJECTIVE: To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).
METHODS: PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy.
RESULTS: The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis.
CONCLUSIONS: Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death.
KEY POINTS: • Frequent findings in cases of fatal opioid intoxication were investigated. • Lung oedema, brain oedema and full urinary bladder represent a highly specific constellation. • This combination of findings in post-mortem CT should raise suspicion of intoxication.

OBJECTIVE: To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).
METHODS: PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy.
RESULTS: The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis.
CONCLUSIONS: Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death.
KEY POINTS: • Frequent findings in cases of fatal opioid intoxication were investigated. • Lung oedema, brain oedema and full urinary bladder represent a highly specific constellation. • This combination of findings in post-mortem CT should raise suspicion of intoxication.

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5 citations in Web of Science®
7 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Institute of Legal Medicine
Dewey Decimal Classification:340 Law
610 Medicine & health
Language:English
Date:2014
Deposited On:19 Mar 2014 09:06
Last Modified:05 Apr 2016 17:45
Publisher:Springer
ISSN:0938-7994
Publisher DOI:https://doi.org/10.1007/s00330-014-3128-7
PubMed ID:24599624

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