Radiopaque stomach contents in postmortem CT in suicidal oral medication intoxication: Report of three cases

Aghayev, Emin; Jackowski, Christian; Christe, Andreas; Thali, Michael

doi:10.1016/j.jflm.2009.10.001

« Previous Next »Journal of Forensic and Legal Medicine
Volume 17, Issue 3 , Pages 164-168, April 2010

Radiopaque stomach contents in postmortem CT in suicidal oral medication intoxication: Report of three cases

Emin Aghayev, MD (Research Assistant)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
- Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
- Corresponding author. Address: Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland. Tel.: +41 31 631 59 40; fax: +41 31 631 59 31.
Christian Jackowski, MD (Research Assistant)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
Andreas Christe, MD (Radiologist)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
- Institute for Diagnostic Radiology, University Hospital of Bern, Inselspital, CH-3010 Bern, Switzerland
Michael Thali, MD (Chief)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland

Received 12 February 2008; received in revised form 16 August 2009; accepted 29 October 2009.

Abstract

In clinical medicine, plane radiography is used for detecting the remains of medications in the stomach in oral medication intoxication cases. Since postmortem computed tomography (CT), performed prior to autopsy, is currently intensively entering the forensic routine, the technique was applied to three fatal cases of oral medication intoxication. Here we report CT and autopsy findings for these cases.

In all three cases, hyperdense areas within the stomach content were documented. The measurement of Hounsfield Units (HU) beyond 74HU showed mean values of 338, 88 and 98HU. Postmortem CT also showed brain edema and pulmonary aspiration in one case. At autopsy, tablet remains in the stomach were detected microscopically in all three cases. The ex vivo CT scans of the ingested medicaments showed similar HU values.

Despite the fact that further case studies are necessary beyond this one, and in spite of its limitations, postmortem CT was found to be a useful screening and documentation method for stomach contents in oral medication intoxication.

Keywords: Forensic radiology, Virtopsy, Computed tomography, Stomach contents, Tablet remains