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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(03): 305-309
DOI: 10.4103/ijri.IJRI_2_19
Miscellaenous

Postmortem CT scan in intoxication cases: A necessity or just an indulgence

Lai Poh Soon
Department of Forensic Medicine, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur
,
Kunasilan Subramaniam
Department of Forensic Medicine, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur
,
Nor Fadhilah Madon
Department of Forensic Medicine, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur
,
Mohamad Helmee Mohamad Noor
Department of Forensic Medicine, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur
,
Mansharan Kaur Chainchel Singh
Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForm), Universiti Teknologi MARA (UiTM), Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia, Aras 4, Bangunan Akademik, Kampus Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
,
Mohd Shah Mahmood
Department of Forensic Medicine, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur
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Abstract

Introduction: The aim of this study is to correlate urinary bladder distension and pulmonary edema on postmortem computed tomography (CT) scans with toxicology results in postmortem cases. Methods and Results: The study population was the postmortem cases of Asian population ranging from 16 to 75 years old in which blood and/or urine samples sent for alcohol and/or drug of abuse (DoA) analysis in year 2016 at our centre. Out of 434 cases, 54 from each group of positive and negative alcohol and/or DoA. Postmortem findings of lungs and postmortem CT scan urinary bladder volume (UBV) were recorded. Statistical significant correlation was obtained between urinary bladder distension on postmortem CT scan and cases with positive alcohol detection. However, the sensitivity was relatively low at 51.7%, whereas the specificity was 75% at the cut-off point. Low sensitivity and specificity at around 52.7% were obtained for pulmonary edema related to alcohol/DoA. This showed that UBV alone or pulmonary edema alone was not really a good indicator for alcohol or DoA intoxication. However, combination of both indicators provided higher sensitivity (73.3%) although specificity was lowered to 53.8%. Conclusion: The findings of postmortem CT scan bladder distension and pulmonary edema could possibly identify intoxication cases but not conclusive.

Keywords

Postmortem computed tomography - pulmonary edema - toxicology-related deaths - urinary bladder distension


Publication History

Received: 14 February 2019

Accepted: 20 August 2019

Article published online:
22 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Legal dictionary [Internet]. West’s Encyclopedia of American Law. edition 2. [updated 2008]. Available from: https://legal dictionary.thefreedictionary.com/Intoxication. [Last accessed on 2018 May 24]
    Google Scholar
  • 2 Saukko P, Knight B. Knight’s Forensic Pathology. 4th ed. London: CRC Press; 2015
    CrossrefGoogle Scholar
  • 3 Aghayev E, Jackowski C, Christe A, Thali MJ. Radiopaque stomach contents in postmortem CT in suicidal oral medication intoxication: Report of three cases. J Forensic Leg Med 2010; 17: 164-8
    CrossrefPubMedGoogle Scholar
  • 4 Uchigasaki S, Lach H, Oesterhelweg L, Sperhake JP, Püschel K, Oshida S. Postmortem measurement of the urine volume by ultrasonography. Rechtsmedizin 2003; 13: 371-3
    CrossrefGoogle Scholar
  • 5 Winklhofer S, Surer E, Ampanozi G, Ruder T, Stolzmann P, Elliott M. et al. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: Frequent findings and comparison to autopsy. Eur Radiol 2014; 24: 1276-82
    CrossrefPubMedGoogle Scholar
  • 6 Rohner C, Franckenberg S, Schwendener N, Oestreich A, Kraemer T, Thali MJ. et al. New evidence for old lore – Urinary bladder distension on post-mortem computed tomography is related to intoxication. Forensic Sci Int 2013; 225: 48-52
    CrossrefPubMedGoogle Scholar
  • 7 Hofer M. Ultrasound Teaching Manual: The Basics of Performing and Interpreting Ultrasound Scans. Stuttgart: Thieme; 2005
    Google Scholar
  • 8 Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H. et al. Common postmortem computed tomography findings following atraumatic death: Differentiation between normal postmortem changes and pathologic lesions. Korean J Radiol 2015; 16: 798-809
    CrossrefPubMedGoogle Scholar
  • 9 Thali MJ, Viner MD, Brogdon BG. Brogdons forensic radiology. Boca Raton: CRC Press; 2011
    Google Scholar