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

Winklhofer, Sebastian; Surer, Eddie; Ampanozi, Garyfalia; Ruder, Thomas D.; Stolzmann, Paul; Elliott, Marina; Oestreich, Andrea; Kræmer, Thomas; Thali, Michael J.; Alkadhi, Hatem; Schweitzer, Wolf

doi:10.1007/s00330-014-3128-7

Cited by 44 publications

(24 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conversely, pulmonary edema is also seen after intoxication, such as heroin [41][42][43] or alcohol intoxication. In our control group, lungs weighed, on an average, 1,599 ± 524 g and PMCT lung attenuation was -546 ± 152 HU.…”

Section: Discussionmentioning

confidence: 95%

Postmortem pulmonary CT in hypothermia

Schweitzer

Thali

Giugni

et al. 2014

Forensic Sci Med Pathol

Self Cite

View full text Add to dashboard Cite

Fatal hypothermia has been associated with pulmonary edema. With postmortem full body computed tomography scanning (PMCT), the lungs can also be examined for CT attenuation. In fatal hypothermia cases low CT attenuation appeared to prevail in the lungs. We compared 14 cases of fatal hypothermia with an age-sex matched control group. Additionally, 4 cases of carbon monoxide (CO) poisoning were examined. Furthermore, 10 test cases were examined to test predictability based on PMCT. Two readers measured CT attenuation on four different axial slices across the lungs (blinded to case group and other reader's results). Hypothermia was associated with statistically significantly lower lung PMCT attenuation and lower lung weights than controls, and there was a dose-effect relationship at an environmental temperature cutoff of 2 °C. CO poisoning yielded low pulmonary attenuation but higher lung weights. General model based prediction yielded a 94% probability for fatal hypothermia deaths and a 21% probability for non-hypothermia deaths in the test group. Increased breathing rate is known to accompany both CO poisoning and hypothermia, so this could partly explain the low PMCT lung attenuation due to an oxygen dissociation curve left shift. A more marked distension in fatal hypothermia, compared to CO poisoning, indicates that further, possibly different mechanisms, are involved in these cases. Increased dead space and increased stiffness to deflation (but not inflation) appear to be effects of inhaling cold air (but not CO) that may explain the difference in low PMCT attenuation seen in hypothermia cases.

show abstract

Section: Discussionmentioning

confidence: 95%

Postmortem pulmonary CT in hypothermia

Schweitzer

Thali

Giugni

et al. 2014

Forensic Sci Med Pathol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although not evaluated, it seems there is no difference in myocardial and coronary indices between methadone-na€ ıve and methadone-dependent patients and the most common cause of death is respiratory depression in all groups [26]. Pulmonary oedema reported in autopsy findings is compatible with opioid toxicity and is reported several times in previous methadone-related death studies [27,28]. However, iatrogenic withdrawal syndrome caused by naloxone administration would still be a risk factor for mortality [22].…”

Section: Discussionmentioning

confidence: 99%

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

Gharehdaghi

Takalloo-Bakhtiari

Hassanian‐Moghaddam

et al. 2017

Basic Clin Pharma Tox

View full text Add to dashboard Cite

High mortality rates have been reported for methadone in both adults and children. We aimed to determine the pattern of toxicity, possible underlying diseases and treatment challenges in patients referred to our centre with early diagnosis of methadone toxicity and who later died. Medical files of all methadone-poisoned patients who had been admitted to a referral centre of toxicology between March 2011 and March 2016, died during the hospital stay and sent for autopsy to Legal Medicine Organization were retrospectively evaluated. In a total of 94 patients, autopsy findings and laboratory evaluations showed that cause of death was pure methadone toxicity in 57 (60.6%). Other causes of death were ischaemic heart disease in ten, co-ingestions (toxicities including methadone) in eight, brain haemorrhage, multi-organ failure and pneumosepsis (each in four), meningitis/encephalitis in three and head trauma and other toxicities (other than methadone but including an opioid, each in two) patients. Time of cardiopulmonary arrest was significantly different between those with pure methadone toxicity and those who died due to other causes (p = 0.01). Patients who had died due to co-ingestions and other toxicities were younger (p = 0.029) and took more bolus doses of naloxone (p = 0.042). In methadone users, especially in older ages and those with trivial response to naloxone administration, loss of consciousness should not be strictly attributed to methadone toxicity. In such patients, thorough evaluation for other possible causes of loss of consciousness is mandatory.

show abstract

“…High levels of substances alone are not diagnostic of a drug-related fatality, and low levels in the appropriate setting with certain autopsy findings may indicate a drug-related fatality. Winklhofer et al verified multiple autopsy findings commonly present in opioid fatalities by the use of postmortem computed tomography including "pulmonary edema (95%), aspiration (66%), distended urinary bladder (42%), cerebral edema (49%), pulmonary emphysema (38%), and fatty liver disease (36%)" (2). Dinis-Oliveira and cohorts documented and explored "foam cones" and pulmonary edema following heroin-related fatalities (3).…”

mentioning

confidence: 99%

Increased Lung Weights in Drug‐related Fatalities

Chen

deJong

2017

Journal of Forensic Sciences

View full text Add to dashboard Cite

This study is of autopsy data for potential validation as to whether increased weights of the lungs support toxic effects of drugs as the cause of death. This retrospective study compared data from 133 deaths resulting from the toxic effects of drugs with previously reported normal lung weights (Toxicol Mech Methods, 22, 2012, 159; Am J Forensic Med Pathol 33, 2012, 368). The lung weights and their standard errors were used in a two-sample independent t-test comparing the average drug-related death weight to the average control weights. To account for multiple comparisons, a Bonferroni-adjusted alpha level of 0.0125 was used. We are 98.75% confident that the mean right lung weight for female drug-related deaths is between 227 and 377 g greater than the mean right lung weight for female non-drug-related deaths. We are 98.75% confident that the mean right lung weight for male drug-related deaths is between 245 and 378 g greater than the mean right lung weight for male non-drug-related deaths.

show abstract

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

Abstract: 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.

Cited by 44 publications

References 37 publications

Postmortem pulmonary CT in hypothermia

Postmortem pulmonary CT in hypothermia

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

Increased Lung Weights in Drug‐related Fatalities

Contact Info

Product

Resources

About