heroin and Cardiomegaly

To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).. 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.. 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.. 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.. 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.

Topics: Adolescent; Adult; Autopsy; Brain Edema; Cardiomegaly; Cause of Death; Female; Forensic Pathology; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Narcotics; Pulmonary Edema; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Urinary Bladder; Whole Body Imaging; Young Adult

Both acute overdose reaction and near-drowning may present as pulmonary edema. With both, the heart is usually not enlarged and clearing occurs within 48 hours, unless complicated by infection or aspiration. In near-drowning there is metabolic acidosis, whereas in acute overdose reaction there is combined respiratory and metabolic acidosis.

Topics: Adult; Barbiturates; Carbon Dioxide; Cardiomegaly; Dextropropoxyphene; Diagnosis, Differential; Drowning; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Oxygen; Pulmonary Edema; Radiography; Substance-Related Disorders

Topics: Aneurysm, Infected; Arterial Occlusive Diseases; Cardiomegaly; Edema; Endocarditis, Bacterial; Hand; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Lung Diseases; Lymphadenitis; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Substance-Related Disorders; Tuberculosis, Pulmonary; Vascular Diseases; Venous Insufficiency