title: The use of postmortem computed tomography in the diagnosis of intentional medication overdose.
abstract: The recognition of a well defined basal layer of radio dense material on the postmortem computed tomography (CT) images, in the setting of typical scene findings of an intentional medication overdose and unremarkable external examination of the deceased's body can, in certain circumstances, permit such cases to be managed without routine full autopsy examination. Preliminary toxicological analysis can be targeted to such cases to provide further supportive evidence of intentional medication overdose. In cases where the scene findings are ambiguous or have been contaminated the postmortem CT images may alert the pathologist of the possibility of overdose in an otherwise apparently natural death. We reviewed 61 cases of documented intentional therapeutic medication overdose and 61 control cases. In the majority of the cases of confirmed intentional therapeutic medication overdose the CT images showed no diagnostic features. However, in many cases a well defined basal layer of radio-opaque material was clearly seen to line the gastric mucosa. The postmortem CT pattern which we believe to be highly suggestive of intentional medication overdose must be differentiated from other causes of increased radio density in the stomach which include CT artefacts.
authors.affiliation: Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Southbank, VIC 3006, Australia. michaelb@vifm.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Burke
authors.forename: Chris
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Richard
authors.initials: R
authors.lastname: Bassed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D001344:Autopsy; D016022:Case-Control Studies; D002423:Cause of Death; D062787:Drug Overdose / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000523:psychology; D004350:Drug Residues; D005260:Female; D049429:Forensic Pathology; D044707:Forensic Sciences / Q000379:methods*; D053593:Forensic Toxicology; D005753:Gastric Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D013405:Suicide / Q000523:psychology*; D014057:Tomography, X-Ray Computed; D014739:Victoria; D055815:Young Adult
references.citation: Forensic Sci Int. 2008 Jul 18;179(1):e16-7
references.pmid: 18502067
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references.pmid: 20211459