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

In: European Radiology, 2014, vol. 24, no. 6, p. 1276-1282

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    Summary
    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.