Abstract
Background:To determine if heroin body packing has occurred using computed tomography (CT), and to evaluate the role of CT in screening such cases.Methods:We collected 158 cases of suspected drug packers' imaging materials (all underwent CT, 42 cases were imaged using plain x-ray film) from September 5, 2005 to April 23, 2008. Abdominal-pelvic CT appearances (shape, size, number, location and density) and abdominal plain x-ray film manifestations were retrospectively observed for those who were finally confirmed as heroin body packers through the passing of evacuated drug packets.Results:Among 158 cases of suspected drug packers in our study, 124 cases were finally diagnosed as heroin body packers. This was consistent with the CT results. However, there were 2 false-negative cases of abdominal imaging taken with plain x-ray film. All of the evacuated heroin body packets were produced mechanically. CT and plain film characteristic findings included the presence of uniform shape, varied density, and well-defined round or ovoid intra-luminal foreign-body shadows arranged closely along the gastrointestinal (GI) tract and/or vagina. We also found that the “air-ring sign” and “onion sign” were valuable characteristics that were seen on the CT scan, which helped to positively confirm the detection of heroin packets.Conclusion:Heroin body packing has clearly defined diagnostic features that can be seen with CT. Furthermore, conventional abdominal-pelvic CT is the imaging modality of choice in the evaluation of suspected body packers.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. Sengupta A, Page P. Window manipulation in diagnosis of body packing using computed tomography. Emerg Radiol 2008;15:203–205.SenguptaA]]PagePWindow manipulation in diagnosis of body packing using computed tomography.Emerg Radiol200815203-2052. Krishnan A, Brown R. Plain abdominal radiography in the diagnosis of the “body packer.” J Accid Emerg Med 1999;16:381.KrishnanA]]BrownRPlain abdominal radiography in the diagnosis of the “body packer.”J Accid Emerg Med1999163813. Horrocks AW. Abdominal radiography in suspected “bodypackers.” Clin Radiol 1992;45:322–325.HorrocksAWAbdominal radiography in suspected “bodypackers.”Clin Radiol199245322-3254. Beck NE, Hale JE. Cocaine “body packers.” Br J Surg 1993;80:1513–1516.BeckNE]]HaleJECocaine “body packers.”Br J Surg1993801513-15165. Taheri MS, Hassanian-Moghaddam H, Birang S, et al. Swallowed opium packets: CT diagnosis. Abdom Imaging 2008;33:262–266.TaheriMS]]Hassanian-MoghaddamH]]BirangS&etal;Swallowed opium packets: CT diagnosis.Abdom Imaging200833262-2666. Meyers MA. The inside dope: cocaine, condoms, and computed tomography. Abdom Imaging 1995;20:339–340.MeyersMAThe inside dope: cocaine, condoms, and computed tomography.Abdom Imaging199520339-3407. Traub SJ, Hoffman RS, Nelson LS. Body packing: the internal concealment of illicit drugs. N Engl J Med 2003;349:2519–2526.TraubSJ]]HoffmanRS]]NelsonLSBody packing: the internal concealment of illicit drugs.N Engl J Med20033492519-25268. Greenberg R, Greenberg Y, Kaplan O. “Body packer” syndrome: characteristics and treatment—case report and review. Eur J Surg 2000;166:89–91.GreenbergR]]GreenbergY]]KaplanO“Body packer” syndrome: characteristics and treatment—case report and review.Eur J Surg200016689-919. Pidoto RR, Agliata AM, Bertolini R, et al. A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers. J Emerg Med 2002;23:149–153.PidotoRR]]AgliataAM]]BertoliniR&etal;A new method of packaging cocaine for international traffic and implications for the management of cocaine body packers.J Emerg Med200223149-15310. Pinsky MF, Ducas J, Ruggere MD. Narcotic smuggling: the double condom sign. J Can Assoc Radiol 1978;29:79–81.PinskyMF]]DucasJ]]RuggereMDNarcotic smuggling: the double condom sign.J Can Assoc Radiol19782979-8111. Brown JA, Phang PT, Enns R, et al. Computed tomography to detect body packing: an unusual cause of small bowel obstruction. Can Assoc Radiol J 2002;53:84–86.BrownJA]]PhangPT]]EnnsR&etal;Computed tomography to detect body packing: an unusual cause of small bowel obstruction.Can Assoc Radiol J20025384-8612. Wilgoren J. Misdiagnosis led to man's handcuffing, suit claims. New York Times, December 6, 1998, p 62.13. Karhunen PJ, Suoranta H, Penttila A, et al. P. Pitfalls in the diagnosis of drug smuggler's abdomen. J Forensic Sci 1991;36:397–402.KarhunenPJ]]SuorantaH]]PenttilaA&etal;P. Pitfalls in the diagnosis of drug smuggler's abdomen.J Forensic Sci199136397-40214. Traub SJ, Hoffman RS, Nelson LS. Falsepositive abdominal radiography in a body packer resulting from intraabdominal calcifications. Am J Emerg Med 2003;21:607–608.TraubSJ]]HoffmanRS]]NelsonLSFalsepositive abdominal radiography in a body packer resulting from intraabdominal calcifications.Am J Emerg Med200321607-60815. Leo PJ, Sachter JJ, Melrose M. Heroin body packing. J Accid Emerg Med 1995;12:43–48.LeoPJ]]SachterJJ]]MelroseMHeroin body packing.J Accid Emerg Med19951243-4816. Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol 2004;14:736–742.HerganK]]KoflerK]]OserWDrug smuggling by body packing: what radiologists should know about it.Eur Radiol200414736-74217. Hartoko TJ, Demey HE, De Schepper AM, et al. The body packer syndrome-cocaine smuggling in the gastro-intestinal tract. Klin Wochenschr 1988;66:1116–1120.HartokoTJ]]DemeyHE]]De SchepperAM&etal;The body packer syndrome-cocaine smuggling in the gastro-intestinal tract.Klin Wochenschr1988661116-112018. Hahn IH, Hoffman RS, Nelson LS. Contrast CT scan fails to detect the last heroin packet. J Emer Med 2004;27:279–283.HahnIH]]HoffmanRS]]NelsonLSContrast CT scan fails to detect the last heroin packet.J Emer Med200427279-283