title: Imaging of body packing: errors and medico-legal issues.
abstract: Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers.
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 12, 80138, Naples, Italy. alfonso.reginelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Reginelli
authors.affiliation: Department of Radiology, S. G. Moscati Hospital, Aversa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 12, 80138, Naples, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Urraro
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 12, 80138, Naples, Italy.
authors.forename: Duilia
authors.initials: D
authors.lastname: Maresca
authors.affiliation: Department of Radiology, S. G. Moscati Hospital, Aversa, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Martiniello
authors.affiliation: Department of Radiology, S. G. Moscati Hospital, Aversa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Department of Health Science, University of Molise, Campobasso, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.affiliation: Department of Radiology, Cardarelli Hospital, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D003042:Cocaine; D003951:Diagnostic Errors; D003952:Diagnostic Imaging; D004349:Drug Packaging / Q000331:legislation & jurisprudence / Q000379:methods*; D064423:Drug Trafficking / Q000331:legislation & jurisprudence*; D005547:Foreign Bodies / Q000175:diagnosis*; D003932:Heroin; D006801:Humans; D013287:Illicit Drugs / Q000331:legislation & jurisprudence*; D008279:Magnetic Resonance Imaging; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D013287:Illicit Drugs; D003932:Heroin; D003042:Cocaine
keywords: Abdominal X-ray; Body packing; Computed tomography; Drug smuggling; Emergency; Errors