Usefulness of Lung Window in Evaluating Abdominal Computed Tomography of Drug Mules

Fatemeh Vakilian; Makhtoom Shahnazi; Hooman Bahrami-Motlagh; Hossein Hassanian Moghaddam

doi:10.5812/iranjradiol.21281

Abstract

Background:

With increasing rate of drug smuggling, the emerging legal implications and possible need for urgent surgery in drug mules make early and accurate diagnosis important. It has recently been recommended to review the abdominal computed tomography (CT) of suspected drug mules in lung window for better delineation of ingested packets and pellets.

Objectives:

We conducted a study to examine the usefulness of adding lung window to conventional abdominal window.

Patients and Methods:

At a major toxicology referral center, 40 suspects (35 males and 5 females) who had undergone abdominal CT scan were included in the study, and their scans were reviewed by a board-certified radiologist in both abdominal and lung windows. The gold standard was detection of packs in stool examination or surgery which was positive in 25 patients.

Results:

The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of abdominal CT scan with conventional abdominal window in detection of drug mules were 50%, 100%, 100%, 46%, and 65% respectively which increased to 53.5%, 100%, 100%, 48%, and 67.5% after adding lung window. Adding lung window, only one body stuffer who was over looked on abdominal window for the hypodense peripheral cover of the pack could be detected additionally. However, more number of packs were detected (mean 7.4 vs. 6.9) and the difference was significant (P = 0.04).

Conclusions:

Reviewing the abdominal CT scan of drug mules in lung window helps to detect more number of ingested packets and pellets; however its usefulness is strongly related to the way ingested packs are fashioned. Small pellets with loose wraps are not well visualized even on lung window and are more prone to leak in the gastrointestinal tract.

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