• Sebastian Winklhofer, Eddie Surer, Garyfalia Ampanozi, Thomas Ruder, Paul Stolzmann, Marina Elliott, Andrea Oestreich, Thomas Kraemer, Michael Thali, Hatem Alkadhi, and Wolf Schweitzer.
• Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland, sebastian.winklhofer@usz.ch.
• Eur Radiol. 2014 Jun 1; 24 (6): 1276-82.

ObjectiveTo investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).MethodsPMCT 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.ResultsThe 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.ConclusionsFrequent 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.Key PointsFrequent 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.

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