2.9. CT imaging as a valuable additional tool to establish drug abuse as cause of death

Purpose To establish drug abuse as cause of death is cumbersome due to sampling difficulties and equivocal lethal concentrations of drugs in blood/urine. Post-mortem CT can give insight into the pathophysiology leading to death, like pulmonary congestion. Therefore the aim of the present study was to identify the most important radiological criteria to detect intoxication as cause of death. Subjects and method Between November 2010 and July 2013 11 bodies (largest study in literature) with the suspicion of intoxication were scanned on a Dual Source CT-scanner with a slice thickness of 1mm. All CT images were evaluated, blinded for toxicology, for pulmonary oedema without pleural effusion, fluid level in main bronchus and other causes of death. Bladder extension could not being measured due to standard urine sampling prior to imaging. Toxicology data and all case information were collected. Results Ten victims showed potentially lethal concentrations of drugs in their samples; amphetamine ( n =5), opiate ( n =1) and combination of amphetamine, cocaine and/or GHB ( n =4). Massive lung embolism without pulmonary oedema was found in the remaining victim on CT imaging. For detecting intoxication as cause of death, pulmonary oedema without pleural effusion had a sensitivity/specificity of 100%, while a fluid level in a main bronchus showed a sensitivity and specificity of 80% and 100%, respectively. Conclusion These results demonstrate that CT-imaging could be a valuable additional tool to establish intoxication as cause of death. In drug abuse victims pulmonary oedema (without pleural effusion) was often depicted in combination with a fluid level in a main bronchus.