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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

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

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    Titre
    • Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy
    Auteur
    • Winklhofer, Sebastian. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Surer, Eddie. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Ampanozi, Garyfalia. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Ruder, Thomas. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Stolzmann, Paul. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Elliott, Marina. Department of Archaeology, Simon Fraser University, 8888 University Drive, V5A 1S6, Burnaby, BC, Canada
    • Oestreich, Andrea. Department of Forensic Pharmacology and Toxicology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Kraemer, Thomas. Department of Forensic Pharmacology and Toxicology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Thali, Michael. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    • Alkadhi, Hatem. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Schweitzer, Wolf. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Radiology, 2014, vol. 24, no. 6, p. 1276-1282. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325420
    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.