European Radiology

, Volume 24, Issue 6, pp 1276–1282

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

Authors

    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
    • Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich
  • Eddie Surer
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
  • Garyfalia Ampanozi
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
  • Thomas Ruder
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
    • Institute of Diagnostic, Interventional and Pediatric RadiologyUniversity Hospital Bern
  • Paul Stolzmann
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
    • Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich
  • Marina Elliott
    • Department of ArchaeologySimon Fraser University
  • Andrea Oestreich
    • Department of Forensic Pharmacology and Toxicology, Institute of Forensic MedicineUniversity of Zurich
  • Thomas Kraemer
    • Department of Forensic Pharmacology and Toxicology, Institute of Forensic MedicineUniversity of Zurich
  • Michael Thali
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
  • Hatem Alkadhi
    • Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich
  • Wolf Schweitzer
    • Department of Forensic Medicine and Radiology, Institute of Forensic MedicineUniversity of Zurich
Forensic Medicine

DOI: 10.1007/s00330-014-3128-7

Cite this article as:
Winklhofer, S., Surer, E., Ampanozi, G. et al. Eur Radiol (2014) 24: 1276. doi:10.1007/s00330-014-3128-7

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.

Keywords

Forensic pathology Post-mortem diagnosis Heroin Opioid Computed tomography

Copyright information

© European Society of Radiology 2014