Walking on thin ice! Identifying methamphetamine “drug mules” on digital plain radiography

Abstract

Objective: The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). Methods:The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all "drug mules" and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces.Results: There were 16 true-positive "drug mules" identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n 5 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n 5 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%.

Unusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder

“…Another risk of rectally inserted objects is rectal bleeding, but this is usually self-limited [6] . Further complications, such as the development of fistulas, infections, abscesses, intoxication, and death, are described in the literature [ 3 , [7] , [8] , [9] , [10] ].…”

“…Berger et al., Rashid et al., and Flach et al. described another type of foreign body, drug containers used for smuggling, that could be detected by conventional radiography, CT, low-dose linear slit digital radiography, or PMCT [8] , [9] , [10] . Most of these so-called body packers remain asymptomatic while smuggling, but the internal packages may leak or rupture and can cause perforation, bowel obstruction, intoxication, and death [9] .…”

“…wrote about deliberate ingestion due to psychiatric diagnoses such as borderline personality disorder [2] . These articles present clinical cases in which CT (for example) can be a helpful tool in the detection and visualization of ingested foreign bodies; additionally, CT can guide surgeons in determining the location of a foreign body [ 6 , 9 ]. In living individuals, imaging procedures such as CT represent a decisive diagnostic method leading to fast and appropriate, and likely life-saving, therapy for affected patients.…”