New evidence for old lore – Urinary bladder distension on post-mortem computed tomography is related to intoxication

Rohner, Carolina; Franckenberg, Sabine; Schwendener, Nicole; Oestreich, Andrea; Kræmer, Thomas; Thali, Michael J.; Hatch, Gary M.; Ruder, Thomas D.

doi:10.1016/j.forsciint.2012.03.029

Cited by 16 publications

(16 citation statements)

References 9 publications

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“…The pathophysiological mechanisms are not known, however. Distension of the urinary bladder in PMCT, which is probably indicative of a relatively long agony as well as opiate-induced sphincter dysfunction, has previously been documented in cases of lethal intoxication [8,40,41]. We found a distended bladder in multiple cases of the drug-death individuals but only in a few cases of the control group.…”

Section: Discussionsupporting

confidence: 65%

“…(7) The upper and lower airways were assessed for fluid levels or for fluid due to aspiration [5,32,33]. (8) The liver was evaluated for steatosis, defined as parenchymal liver attenuation ≤40 Hounsfield units (HU) [34][35][36]. (9) Maximal transverse diameter of the urinary bladder to distinguish between distended or non-distended urinary bladder, as described by Rohner et al [8], with a cutoff value of 8.5 cm.…”

Section: Radiological Criteriamentioning

confidence: 99%

“…Computed tomography (CT) represents the most promising imaging modality in post-mortem investigations, having the potential to reduce autopsy workloads and related biohazard exposures-also when investigating cases that turn out to be related to drug abuse and other intoxications [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

et al. 2014

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Section: Discussionsupporting

confidence: 65%

Section: Radiological Criteriamentioning

confidence: 99%

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Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

et al. 2014

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“…They also have true correlation among one another. This study concurred with the indings by C. Rohner et al (2013) where AUBD have the highest strength of positive relationship with calculated UBV at r=9.939, p<0.001, followed by parameter C at r=9.934, p<0.001 (Table 2) [3]. There was a signi icant positive correlation at low strength between alcohol concentrations with calculated UBV.…”

Section: Resultssupporting

confidence: 90%

“…Signi icance levels for UBV in relation to toxicology results were investigated with the Mann-Whitney test. Both calculated UBV and axial urinary bladder diameter (AUBD) were subjected to receiver operating characteristics curve analysis whereby the sensitivity and speci icity were calculated for individual cut-off values [3].…”

Section: Introductionmentioning

confidence: 99%

Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post-mortem Computed Tomography (PMCT): A Validation Study

Poh¹

2018

J Forensic Sci Res

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Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine. Urinary bladder volume (UBV) was calculated based on the equation used in ultrasonographic volumetry, V=axbxcx 0.5. These 3 parameters correlated well with the UBV and having a strong positive relationship. There was a signifi cant positive correlation at low strength between alcohol concentrations with calculated UBV. There was statistical signifi cant correlation between urinary bladder distension on postmortem CT and cases of intoxication especially more corresponding for positive alcohol detection. The average sensitivity was 35.65% whereby it was slightly lower than those reported in Rohner C, et al. In this study we have deduced that diuretics effect of alcohol was the main reason causing bigger urinary bladder or UBV and was more prominent than the infl uence of drug of abuse on the urinary bladder sphincter. The distension of urinary bladder should raise suspicion of intoxication, but would not provide information on the quantity of the intoxicating agent due to its signifi cant but poor correlation. It was important to note that intoxication may also be present in cases with low urinary bladder volume. In conclusion, it is vital to consider circumstantial evidence, as well as the presence of additional fi ndings on imaging before suggesting the diagnosis of intoxication based on urinary bladder distension on imaging. Currently, the use of CT bladder imaging should serve as a strong indication that the individual may be intoxicated but should be confi rmed by a complete autopsy and a detailed toxicological analysis.

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Genauigkeit der Harnblasenvolumetrie

et al. 2016

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New evidence for old lore – Urinary bladder distension on post-mortem computed tomography is related to intoxication

Cited by 16 publications

References 9 publications

Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post-mortem Computed Tomography (PMCT): A Validation Study

Genauigkeit der Harnblasenvolumetrie

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