1
|
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.
Collapse
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
| |
Collapse
|
2
|
|
3
|
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.
Collapse
|
4
|
Esterson YB, Patel V, Nicastro J, Friedman B. Plain radiography may underestimate the burden of body packer ingestion: A case report. Clin Imaging 2017; 44:57-60. [PMID: 28441549 DOI: 10.1016/j.clinimag.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023]
Abstract
Body packing refers to the intracorporeal concealment of illicit drugs. Here we report the case of a 55-year-old body packer who presented with palpitations, visual hallucinations, and a sense of impending death. Abdominal radiography demonstrated five ovoid foreign bodies overlying the rectum. At subsequent gastrotomy and cecotomy, thirty-eight cocaine-containing packets were retrieved from the stomach and ascending colon as well as from the rectum. As the contraband market evolves new techniques to evade detection, evaluation of the burden of body packer ingestion has become increasingly challenging. As demonstrated in this case, plain radiography can grossly underestimate the burden of ingestion.
Collapse
Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Vihas Patel
- Department of Surgery, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Jeffrey Nicastro
- Department of Surgery, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Barak Friedman
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| |
Collapse
|
5
|
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]
|
6
|
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]
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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]
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands,
| | | | | | | | | |
Collapse
|
11
|
Un voyageur pas comme les autres : prise en charge d’un « body-packer ». ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
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.
Collapse
Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Connors NJ, Sekar K, Howland MA, Hoffman RS, Nelson LS. In response to "Detection of body packing by magnetic resonance imaging: a new diagnostic tool?". ABDOMINAL IMAGING 2013; 38:879. [PMID: 23494715 DOI: 10.1007/s00261-013-9994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|