title: Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland, sebastian.winklhofer@usz.ch.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winklhofer
authors.forename: Eddie
authors.initials: E
authors.lastname: Surer
authors.forename: Garyfalia
authors.initials: G
authors.lastname: Ampanozi
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruder
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Marina
authors.initials: M
authors.lastname: Elliott
authors.forename: Andrea
authors.initials: A
authors.lastname: Oestreich
authors.forename: Thomas
authors.initials: T
authors.lastname: Kraemer
authors.forename: Michael
authors.initials: M
authors.lastname: Thali
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Wolf
authors.initials: W
authors.lastname: Schweitzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy / Q000379:methods*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000209:etiology; D002423:Cause of Death; D005260:Female; D049429:Forensic Pathology / Q000379:methods*; D003932:Heroin / Q000009:adverse effects; D006556:Heroin Dependence / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D051598:Whole Body Imaging / Q000379:methods; D055815:Young Adult
chemical_list: D009294:Narcotics; D003932:Heroin; D008691:Methadone