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Cai Y, Wang J, Ou C, Zhu Y, Fang J, Hong Y. The second near-infrared fluorescence concealed imaging for identifying smuggled baggage. Heliyon 2023; 9:e20815. [PMID: 37860536 PMCID: PMC10582487 DOI: 10.1016/j.heliyon.2023.e20815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 07/18/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
Smuggling methods are renovating with more diversified, complicated means, thereby developing concealed and non-sensitive luggage identification technology is of great significance. Herein, for the first time, the second near-infrared (NIR-II, 1000-2500 nm) concealed imaging for identifying smuggled baggage based on organic small molecule luminescent material was studied. A small molecule luminescent material (Y6) with the excitation in invisible near-infrared (NIR) light was used to generate fluorescence-emission in NIR-II region. The traceless Y6 sprayed on the surface of criminal luggage does not emit light under visible light irradiation, but shows hidden NIR-II signs under NIR excitation that can prevent the suspects to find abnormality and lose their luggage. The Y6 organic luminescent material has invisibility, low toxicity, long-term fluorescence stability and high transparency. This NIR-II fluorescence imaging technology can be used as a new type of concealed baggage marking, which is of great significance to help the customs combat smuggling crimes.
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Affiliation(s)
- Yu Cai
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jinling Wang
- Jinling Customs, 111 Jiangjun Road, Jiangning District, Nanjing, Jiangsu, 211100, China
| | - Changjin Ou
- Institute of Advanced Materials and Flexible Electronics (IAMFE), School of Chemistry and Materials Science, Nanjing University of Information Science & Technology, Nanjing, 210044, China
| | - Yuanyuan Zhu
- Jinling Customs, 111 Jiangjun Road, Jiangning District, Nanjing, Jiangsu, 211100, China
| | - Jing Fang
- Jinling Customs, 111 Jiangjun Road, Jiangning District, Nanjing, Jiangsu, 211100, China
| | - Ying Hong
- Jinling Customs, 111 Jiangjun Road, Jiangning District, Nanjing, Jiangsu, 211100, China
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2
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Bonnefoy C, Nacher M, Egmann G, Pastre A, About V, Jeanbourquin D, Louvel D, Hamiche K, Bonifay T. Epidemiology and medical management of body‐packers in French Guiana between 2010 and 2015. J Am Coll Emerg Physicians Open 2022; 3:e12603. [PMID: 35445211 PMCID: PMC9013264 DOI: 10.1002/emp2.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background Method Result Conclusion
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Affiliation(s)
- Clemence Bonnefoy
- Service d'accueil des urgences Centre Hospitalier Cayenne French Guiana France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane Inserm CIC 1424 French Guiana France
- Equipe EA 3593 Ecosystèmes Amazoniens et Pathologie Tropicale Université de Guyane Cayenne French Guiana France
| | - Gerald Egmann
- Service d'accueil des urgences Centre Hospitalier Cayenne French Guiana France
| | - Agathe Pastre
- Unité medico‐judiciaire Centre Hospitalier Cayenne French Guiana France
- Unité sanitaire en milieu pénitentiaire Centre Hospitalier Cayenne French Guiana France
| | - Vincent About
- Service d'accueil des urgences Centre Hospitalier Cayenne French Guiana France
- Unité sanitaire en milieu pénitentiaire Centre Hospitalier Cayenne French Guiana France
| | | | - Dominique Louvel
- Service Hépato Gastro Entérologie Centre Hospitalier Cayenne French Guiana France
| | - Karim Hamiche
- Unité medico‐judiciaire Centre Hospitalier Cayenne French Guiana France
| | - Timothee Bonifay
- Centre d'Investigation Clinique Antilles Guyane Inserm CIC 1424 French Guiana France
- Unité sanitaire en milieu pénitentiaire Centre Hospitalier Cayenne French Guiana France
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3
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Can TS, Yilmaz BK, Ozdemir S. Using CT scout view to scan illicit drug carriers may reduce radiation exposure. J Forensic Leg Med 2021; 81:102202. [PMID: 34153884 DOI: 10.1016/j.jflm.2021.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to present our experience on the evaluation of suspected illicit drug carriers via computerized tomography scout view (CTSV) with analysis of detectability and features such as content, form and density. METHODS A total of 120 individuals suspected of body packing were screened via CT in a university emergency department between January 2014 and December 2017. RESULTS 88.3% of 120 body packing cases examined in the study were male. The median (1st quartile-3rd quartile) age of the cases was 35.5 (30-41) years. We found that solid packs have a 4.573-fold higher likelihood of detection in CTSV screening than liquid ones (95%CI: 1.879-11.134). Additionally, the number of CT scans needed were significantly associated with capsule localization (stomach) (OR:7.178, 95%CI: 2.420-21.293) and solid form packs (OR: 8.705, 95%CI: 2.318-32.692) are associated with number of CT scans. CONCLUSION CTSVs have a successful detection rate, especially in solid form packs. Our results suggest that conclusive CTSV imaging for body packing may be recommended to delay the application of the next CT scan until the passage of the first capsule; thereby preventing unnecessary radiation exposure.
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Affiliation(s)
- Tuba Selcuk Can
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey.
| | - Behice Kaniye Yilmaz
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sevim Ozdemir
- Department of Radiology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
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4
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Puntonet J, Gorgiard C, Soussy N, Soyer P, Dion E. Body packing, body stuffing and body pushing: Characteristics and pitfalls on low-dose CT. Clin Imaging 2021; 79:244-250. [PMID: 34139609 DOI: 10.1016/j.clinimag.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Because of availability and low radiation dose level, low dose computed tomography (CT) is now commonly used to identify illicit in corpore drug transportation. This review illustrates the most common CT findings of in corpore drug transportation and describes complications due to in corpore drug transportation, with a special emphasis on low dose CT. Major information such as number of packets, exact location and aspect of packets must be assessed. Radiologist must be aware of the imaging characteristics of "in corpore" illicit drug transportation, and should know situations that may alter drug smugglers management.
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Affiliation(s)
- Julien Puntonet
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France.
| | - Charlotte Gorgiard
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Nicolas Soussy
- Université de Paris, F-75006 Paris, France; Medicolegal Department - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, 75001 Paris, France
| | - Philippe Soyer
- Université de Paris, F-75006 Paris, France; Department of Radiology- Cochin Hospital, Assistance Publique-Hopitaux de Paris, 75014 Paris, France
| | - Elisabeth Dion
- Department of Radiology - Hotel Dieu Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, F-75006 Paris, France
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5
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Imaging of drug mules. Emerg Radiol 2021; 28:809-814. [PMID: 33738658 DOI: 10.1007/s10140-021-01924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Cocaine, heroin, methamphetamine, and hashish are the primary drugs transported by a body packer, who swallows such packages. A body pusher or stuffer transports drug packages in rectum or vagina. Plain radiography is the primary imaging modality used in the evaluation of concealed drugs and has sensitivity of 85-90%. The imaging features include well-defined opacities in the bowel with crescents of air near ovoid opacities. The imaging signs include double condom sign, halo sign, parallelism sign, and tic tac sign. A low-dose CT is an efficient noninvasive and accurate technique of locating packages internally for all types of concealment.
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Shufflebarger E, DeLaney M, Pigott D. Young Man With Suspected Foreign Body Ingestion. Clin Pract Cases Emerg Med 2019; 3:449-450. [PMID: 31763616 PMCID: PMC6861032 DOI: 10.5811/cpcem.2019.8.44080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 11/17/2022] Open
Abstract
As United States emergency departments (ED) and hospitals continue to contend with increasing numbers of patients presenting with complications of substance abuse, emergency physicians should also be aware of patients who may be smuggling illicit drugs. We report the case of a 26-year-old man who was transported to the ED for suspected drug smuggling. Abdominal computed tomography was notable for the presence of multiple tubular foreign bodies throughout the colon that were later identified as packets containing heroin. Body-packing patients present a high-risk clinical scenario that may result in massive, inadvertent drug exposure.
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Affiliation(s)
- Erin Shufflebarger
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Matthew DeLaney
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - David Pigott
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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7
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Abedzadeh AA, Iqbal SS, Al Bastaki U, Pierre-Jerome C. New packaging methods of body packers: Role of advanced imaging in their detection. A case study. Radiol Case Rep 2019; 14:627-633. [PMID: 30923589 PMCID: PMC6424096 DOI: 10.1016/j.radcr.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 01/08/2023] Open
Abstract
Body packing is one of the common ways to traffic illicit drugs. Drug mules usually swallow or insert drugs within the gastrointestinal tract or other orifices. Detection of such drug packets has become difficult because of the constantly improving packaging techniques and the sophistication used by traffickers. Suspected obstruction or perforated hollow viscus requires employment of appropriate radiological procedures and techniques for accurate detection and precise diagnosis. A delay diagnosis and inappropriate action may carry disastrous physical consequences for the body packers. It is crucial for radiologists to acquire enough experience to deduce different types of drug packets from their imaging characteristics and to accurately guide emergency physicians and security officials. The packets are not always radiodense, therefore they can be difficult to detect on conventional abdominal radiographs. In this report, the authors illustrate 5 cases with different packaging methods and materials that give rise to radiological challenges.
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Affiliation(s)
- Ayoub Ahmad Abedzadeh
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Shaikh Sayeed Iqbal
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Usama Al Bastaki
- Department of Radiology, Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai, United Arab Emirates
| | - Claude Pierre-Jerome
- Department of Radiology, Ackershus University Hospital, Sykehusveien, 75, 1470 Oslo, Norway
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8
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Fung BM, Sweetser S, Wong Kee Song LM, Tabibian JH. Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management. World J Gastrointest Endosc 2019; 11:174-192. [PMID: 30918584 PMCID: PMC6425280 DOI: 10.4253/wjge.v11.i3.174] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
Foreign body ingestion encompasses both foreign object ingestion (FOI) and esophageal food impaction (EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance, its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.
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Affiliation(s)
- Brian M Fung
- UCLA-Olive View Internal Medicine Residency Program, Sylmar, CA 91342, United States
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - James H Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
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10
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Lan K, Doyle E. Is abdominal x-ray (AXR) or computed tomography (CT) of the abdomen the most appropriate imaging modality for the detection of illegal substances concealed, taking into consideration the sensitivity, specificity and radiation dose? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jofri.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Aissa J, Bölke E, Sawicki LM, Appel E, Thomas C, Heusch P, Sedlmair M, Krzymyk K, Kröpil P, Antoch G, Boos J. Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction? Eur J Med Res 2018; 23:59. [PMID: 30526681 PMCID: PMC6284291 DOI: 10.1186/s40001-018-0356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the detection rate and image quality in CT-body-packer-screening at different radiation-dose levels and to determine a dose threshold that enables a reliable detection of incorporated body packs and incidental findings with a maximum of dose saving. Materials and methods We retrospectively included 27 individuals who underwent an abdominal CT with automated exposure control due to suspected body packing. CT images were reconstructed at different radiation-dose levels of 50%, 10, 5% and 1% using iterative reconstructions. All 135 CT reconstructions were evaluated by three independent readers. Reviewers determined the presence of foreign bodies and evaluated the image quality using a 5-point ranking scale. In addition, visualization of incidental findings was assessed. Results A threshold of 5% (effective dose 0.11 ± 0.07 mSv) was necessary to correctly identify all 27 patients with suspected body packing. Extensive noise insertion to a dose level of 1% (0.02 ± 0.01 mSV) led to false-positive solid cocaine findings in three patients. Image quality was comparable between 100 and 50%. The threshold for correct identification of incidental findings was 10% of the initial dose (effective dose 0.21 ± 0.13 mSv). Conclusions Our results indicate that dose of abdominal CT for the detection of intracorporeal cocaine body packets can be markedly reduced to up to 5% of the initial dose while still providing sufficient image quality to detect ingested body packets. However, a minimum effective dose of 0.21 mSv (10% of initial dose) seems to be required to properly identify incidental findings.
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Affiliation(s)
- Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Elisabeth Appel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christoph Thomas
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Martin Sedlmair
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Karl Krzymyk
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Patric Kröpil
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.,Department of Radiology, BG Klinikum Duisburg gGmbH, 47249, Duisburg, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Johannes Boos
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
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Platon A, Herrera B, Becker M, Perneger T, Getaz L, Wolff H, Lock E, Rutschmann O, Poletti PA. Detecting illegal intra-corporeal cocaine containers: Which factors influence their density? Clin Imaging 2018; 51:235-239. [DOI: 10.1016/j.clinimag.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
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Abesamis MG, Taki N, Kaplan R. Uterine Body Stuffing Confirmed by Computed Tomography. Clin Pract Cases Emerg Med 2018; 1:365-369. [PMID: 29849377 PMCID: PMC5965216 DOI: 10.5811/cpcem.2017.5.33495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/27/2017] [Accepted: 05/24/2017] [Indexed: 01/08/2023] Open
Abstract
A 31-year-old woman presented to an emergency department for suspected vaginal “stuffing” of cocaine. Her physical and pelvic exams were unremarkable despite agitation, tachycardia and hypertension. Abdominal radiograph was concerning for foreign body; transabdominal ultrasound was non-diagnostic. A noncontrast abdominal/pelvic computed tomography (CT) revealed a radiopaque mass within the cervix extending into the uterus. Gynecology was consulted, but the patient refused removal and left against medical advice. Radiographs have varied sensitivity for detecting stuffed foreign bodies; CT is more sensitive and specific. This case suggests that CT is suitable to evaluate for this rare event.
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Affiliation(s)
- Michael G Abesamis
- University of Pittsburgh Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Pittsburgh, Pennsylvania
| | - Najeeb Taki
- Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - Richard Kaplan
- Allegheny General Hospital, Department of Emergency Medicine, Pittsburgh, Pennsylvania
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Wankhade VK, Chikhalkar B. Body packing and intra-vaginal body pushing of cocaine: A case report. Leg Med (Tokyo) 2018; 31:10-13. [DOI: 10.1016/j.legalmed.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/05/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
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Bahrami-Motlagh H, Mahboubi-Fooladi Z, Salevatipour B, Hassanian-Moghaddam H, Mirhashemi SH. Comparison of low dose and standard dose abdominal CT scan in body stuffers. Clin Toxicol (Phila) 2017; 56:348-354. [PMID: 28905656 DOI: 10.1080/15563650.2017.1377220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Detection of body stuffers is challenging in emergency departments. Because of the small size of baggies, plain radiograph is of little value in most suspects. On the other hand, abdomen CT scan is burdened by high cost and radiation dose. This study was performed to compare the image quality, radiation dose and accuracy of low-dose CT scan in comparison with standard dose. MATERIAL AND METHODS In this prospective study, suspected body stuffers who were referred to the radiology department underwent two different protocols of abdominal non-contrast CT scan simultaneously: low-dose (with equivalent dose to conventional abdominal x-ray) and standard dose. Standard dose CT scan was considered as the reference. Low-dose CT scans were evaluated for detection of baggies by two radiologists blinded to the result of standard dose CT. Image quality, noise, dose-length product (DLP) and effective dose (ED) compared between two groups. RESULTS The study consisted of 40 patients (33.38 ± 7.4 years). Standard dose CT evaluation was positive in 22 patients (55%). In comparison with standard dose CT scan, low-dose group had a sensitivity of 86%, specificity of 100%, PPV and NPV of 100% and 86%. The accuracy of low-dose CT scan for detection of baggies larger than 1 cm was 100%. However, from the 3 cases that could not be detected with low dose protocol, one had CT features suspected for baggies rupture which was intubated and later deceased. Noise average of low-dose protocol, was approximately 7 times greater than standard dose group, while DLP and ED were 9.7 times less. CONCLUSION Low dose CT scan appears to be an appropriate screening method for body stuffers, especially when the baggies are larger than one centimeter. However, in the presence of severe clinical symptoms, a standard dose CT scan will be more helpful due to better image quality especially in suspected ruptured baggies.
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Affiliation(s)
- Hooman Bahrami-Motlagh
- a Department of Radiology , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Zahra Mahboubi-Fooladi
- a Department of Radiology , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Babak Salevatipour
- a Department of Radiology , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Hossein Hassanian-Moghaddam
- b Department of Clinical Toxicology , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Seyyed Hadi Mirhashemi
- c Department of Surgery , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Death by "Snow"! A Fatal Forensic Case of Cocaine Leakage in a "Drug Mule" on Postmortem Computed and Magnetic Resonance Tomography Compared With Autopsy. Am J Forensic Med Pathol 2017; 38:339-344. [PMID: 28737525 DOI: 10.1097/paf.0000000000000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This forensic case presents unique postmortem imaging of a "drug mule" with fatal intoxication due to cocaine leakage on postmortem computed and magnetic resonance (MR) tomography compared with autopsy.Imaging by postmortem computed and MR tomography was performed before autopsy, histology, and toxicology were commissioned. Forensic imaging revealed 91 hyperdense, uniformly shaped body packs with signs of leakage, which was confirmed by autopsy. Postmortem MR imaging displayed the rarely described hypointense appearance of the body packs in T1- and T2-weighted sequences. Toxicology stated the dosage of cocaine intoxication as lethal.This case provides an opportunity to image internal cocaine drug containers on postmortem computed and MR tomography. The cause of death could be determined based on imaging and the radiological morphology of these packs by both imaging methods.
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Gohmann RF, Heckner F, Uschner D, Katharina Kuhl C, Daniel Reinartz S. Body Pushers: Low-Dose CT, Always the Best Choice? A Study of the Diagnostic Performance of CT Scout View. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojrad.2017.72013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cappelletti S, Piacentino D, Sani G, Bottoni E, Fiore PA, Aromatario M, Ciallella C. Systematic review of the toxicological and radiological features of body packing. Int J Legal Med 2016; 130:693-709. [DOI: 10.1007/s00414-015-1310-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
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19
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Added value of lung window in detecting drug mules on non-contrast abdominal computed tomography. Radiol Med 2016; 121:472-7. [PMID: 26830789 DOI: 10.1007/s11547-015-0618-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/21/2015] [Indexed: 01/08/2023]
Abstract
We evaluated the added value of lung window in non-contrast computed tomography (CT) of suspected body packers or stuffers. Forty suspected drug mules who were referred to our tertiary toxicology center were included. The final diagnosis of drug mule was based on the detection of packs in stool examination or surgery. Non-contrast CT scans were retrospectively interpreted by two blinded radiologists in consensus before and after reviewing the lung window images. The diagnostic performance of abdominal window scans alone and scans in both abdominal and lung windows were subsequently compared. Seven body packers and 21 body stuffers were identified. The sensitivity, negative predictive value (NPV), and diagnostic accuracy of scans in detection of drug mules (either drug packers or stuffers) raised from 60.7, 52.1, and 72.5 to 64.2, 54.5, and 75.0 %, respectively, with a more number of packs being detected (114 vs. 105 packs). In the body packers group, the diagnostic performance of both abdominal windows scans and combined abdominal and lung windows scans were 100 %. In the body stuffers group, the sensitivity, NPV, and diagnostic accuracy of scans increased from 47.6, 52.1, and 55.0 to 52.3, 54.5, and 57.5 %, respectively, after the addition of lung windows. Reviewing the lung window on non-contrast abdominal CT can be helpful in detection of drug mules.
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Bulakci M, Cengel F. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools. Br J Radiol 2016; 89:20150888. [PMID: 26867003 DOI: 10.1259/bjr.20150888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Emergency physicians and radiologists have been increasingly encountering internal concealment of illegal drugs. The packages commonly contain powdered solid drugs such as cocaine, heroin, methamphetamine and hashish, but they may also contain cocaine in the liquid form. The second type of package has recently been more commonly encountered, and poses a greater diagnostic challenge. As clinical evaluation and laboratory tests frequently fail to make the correct diagnosis, imaging examination is typically required. Imaging methods assume a vital role in the diagnosis, follow-up and management. Abdominal X-ray, ultrasonography, CT and MRI are used for the imaging purposes. Among the aforementioned methods, low-dose CT is state-of-the-art in these cases. It is of paramount importance that radiologists have a full knowledge of the imaging characteristics of these packages and accurately guide physicians and security officials.
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Affiliation(s)
- Mesut Bulakci
- 1 Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ferhat Cengel
- 2 Department of Radiology, Haseki Training and Research Hospital, Istanbul, Turkey
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Aissa J, Kohlmeier A, Rubbert C, Hohn U, Blondin D, Schleich C, Kröpil P, Boos J, Antoch G, Miese F. Diagnostic value of CT-localizer and axial low-dose computed tomography for the detection of drug body packing. J Forensic Leg Med 2016; 37:55-60. [DOI: 10.1016/j.jflm.2015.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/17/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
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Shahnazi M, Hassanian-Moghaddam H, Gachkar L, Ahmadi N, Zamani N, Bahrami-Motlagh H, Faghihi Langroudi T, Arjmand Shabestari A, Mohammad Alizadeh A. Comparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers. Clin Toxicol (Phila) 2015; 53:596-603. [PMID: 26065361 DOI: 10.3109/15563650.2015.1054501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose. OBJECTIVE We aimed to evaluate the efficacy of abdominopelvic CT "with" and "without" oral contrast in diagnosis of existence, number, and type of packets in body packers/pushers and stuffers. MATERIALS AND METHODS In a prospective observational case series, all suspected cases of body packing/stuffing were included and underwent abdominopelvic CT with and without oral contrast in a one-year period. CT scans were reported by three independent attending radiologists blind to the demographic and clinical results and compared to our defined "gold standard" which was surgery or expulsion of packets. The existence and number of packets detected by each method were compared to define the better method of diagnosis. RESULTS Of 11 suspect body packers/pushers, 10 carried packs. Abdominopelvic CT with and without oral contrast detected six and seven of them, respectively. In 24 body stuffers, CT without oral contrast was more accurate in diagnosis of existence (9/24 vs. 7/24, p = 0.003) and number (sensitivity and positive predictive values of 29.2% vs. 37.5% and 100% vs. 100% for CTs with and without oral contrast, respectively, p = 0.021). DISCUSSION AND CONCLUSIONS There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.
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Affiliation(s)
- Makhtoom Shahnazi
- Department of Radiology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Scineces , Tehran , Iran
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Low-tube voltage 100 kVp MDCT in screening of cocaine body packing: image quality and radiation dose compared to 120 kVp MDCT. ACTA ACUST UNITED AC 2015; 40:2152-8. [DOI: 10.1007/s00261-015-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asha SE, Cooke A. Sensitivity and Specificity of Emergency Physicians and Trainees for Identifying Internally Concealed Drug Packages on Abdominal Computed Tomography Scan: Do Lung Windows Improve Accuracy? J Emerg Med 2015; 49:268-73. [PMID: 25934379 DOI: 10.1016/j.jemermed.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/18/2014] [Accepted: 02/17/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Suspected body packers may be brought to emergency departments (EDs) close to international airports for abdominal computed tomography (CT) scanning. Senior emergency clinicians may be asked to interpret these CT scans. Missing concealed drug packages have important clinical and forensic implications. The accuracy of emergency clinician interpretation of abdominal CT scans for concealed drugs is not known. Limited evidence suggests that accuracy for identification of concealed packages can be increased by viewing CT images on "lung window" settings. OBJECTIVES To determine the accuracy of senior emergency clinicians in interpreting abdominal CT scans for concealed drugs, and to determine if this accuracy was improved by viewing scans on both abdominal and lung window settings. METHODS Emergency clinicians blinded to all patient identifiers and the radiology report interpreted CT scans of suspected body packers using standard abdominal window settings and then with the addition of lung window settings. The reference standard was the radiologist's report. RESULTS Fifty-five emergency clinicians reported 235 CT scans. The sensitivity, specificity, and accuracy of interpretation using abdominal windows was 89.9% (95% confidence interval [CI] 83.0-94.7), 81.9% (95% CI 73.7-88.4), and 86.0% (95% CI 81.5-90.4), respectively, and with both window settings was 94.1% (95% CI 88.3-97.6), 76.7% (95% CI 68.0-84.1), 85.5% (95% CI 81.0-90.0), respectively. Diagnostic accuracy was similar regardless of the clinician's experience. Interrater reliability was moderate (kappa 0.46). CONCLUSION The accuracy of interpretation of abdominal CT scans performed for the purpose of detecting concealed drug packages by emergency clinicians is not high enough to safely discharge these patients from the ED. The use of lung windows improved sensitivity, but at the expense of specificity.
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Affiliation(s)
- Stephen Edward Asha
- Emergency Department, St George Hospital, Kogarah, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Andrew Cooke
- Emergency Department, St George Hospital, Kogarah, New South Wales, Australia
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The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study. ACTA ACUST UNITED AC 2015; 40:2143-51. [DOI: 10.1007/s00261-015-0430-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers. Clin Radiol 2014; 69:e525-30. [DOI: 10.1016/j.crad.2014.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
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Sica G, Guida F, Bocchini G, Iaselli F, Iadevito I, Scaglione M. Imaging of drug smuggling by body packing. Semin Ultrasound CT MR 2014; 36:39-47. [PMID: 25639176 DOI: 10.1053/j.sult.2014.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Body packing, pushing, and stuffing are hazardous practices with complex medicolegal and social implications. A radiologist plays both a social and a medicolegal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location so as to prevent any package remains in the body packer. Radiologists must also be able to recognize the complications associated with these risky practices. Imaging assessment of body packing is performed essentially through plain abdominal X-ray and computed tomography scans. Ultrasound and magnetic resonance imaging, although with some advantages, actually have a limited use.
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Affiliation(s)
- Giacomo Sica
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Franco Guida
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Francesco Iaselli
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Isabella Iadevito
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy.
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Radiographic features of intracorporeally smuggled liquid cocaine. Forensic Sci Med Pathol 2014; 10:535-42. [PMID: 25326675 DOI: 10.1007/s12024-014-9607-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The radiological features of intracorporeally smuggled cocaine powder are well-established. Liquid cocaine is a novel method for intracorporeal drug smuggling. We describe radiological features of liquid cocaine on abdominal plain films and computerized tomographic (CT) scans and compare them to those of cocaine powder. METHODS Twenty-five suspected cocaine smugglers (13 males, 12 females, average age 38 years) underwent abdominal plain film radiography for drug detection between 2010 and 2014. Ten of them also underwent a CT scan. Eight were found to be smuggling cocaine powder and 17 were found to be smuggling liquid cocaine. We identified two new imaging characteristics unique to intracorporeal liquid cocaine on both plain films and CT scans, and compared them to the radiological features of cocaine powder. RESULTS The radiological features of intraabdominal liquid cocaine packets on plain abdominal films (n = 17) were similar in opacity to bowel content and had an irregular shape that conformed to the intestinal contour. We identified what we termed "thin lucent lines" that were created by gas trapped between the packets. Four CT scans revealed that liquid cocaine was hyperdense compared to bowel content, that the packets had irregular shapes, and that the gas trapped between the packets formed a "jigsaw" pattern, a heretofore non-described finding that was present in all four scans. CONCLUSIONS Liquid cocaine has several unique imaging features that assist its detection on abdominal plain film. A CT scan can assist detection in inconclusive cases by demonstrating hyperdense irregular packets of liquid cocaine and a "jigsaw" pattern of gas between them.
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Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M. Body packing: a review of general background, clinical and imaging aspects. Radiol Med 2014; 120:118-32. [PMID: 25300715 DOI: 10.1007/s11547-014-0458-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
Abstract
To avoid detection at border crossings or airport customs, drug trafficking is increasingly performed by intra-corporeal concealment. Body packers may ingest packets of varying size and containing varying drugs (mostly cocaine, heroin and cannabis) mixed with other compounds, while body pushers will insert packets in the rectum or vaginal cavity. Body packing may lead to potential life-threatening complications with acute overdose syndromes after packet rupture and intestinal obstruction with possible ensuing bowel rupture being the most significant complications. Physicians including radiologists should be aware of the capabilities of imaging techniques to screen for presence of drug packets as well as the potential complications. Although conventional radiography has long been and still is the most important imaging modality for screening for presence of intestinal packets, the better test characteristics in conjunction with the decreasing radiation exposure, will likely render computed tomography (CT) more important in the future. For imaging of symptomatic patients, CT already is the modality of choice. Besides these modalities, ultrasound and magnetic resonance imaging will be discussed in this paper, together with more general background and clinical information.
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Affiliation(s)
- Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands,
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Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, Romano L, Brunese L. Radiological and practical aspects of body packing. Br J Radiol 2014; 87:20130500. [PMID: 24472727 DOI: 10.1259/bjr.20130500] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.
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Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
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