Fatal hemorrhage complicated with methamphetamine poisoning and its postmortem CT features

Currently, attempts to utilize postmortem images (mainly CT) in the process of death investigation are becoming more and more common in both forensic and clinical practice. It is thought that the detection rate of the cause of death using postmortem CT is about 30%, and CT offers an advantage of detecting fatal hemorrhagic lesions. However, the challenges associated with distinguishing exogenous from endogenous deaths using CT images are not widely known. In some countries, such as Japan, where postmortem CT scans are not a prerequisite for toxicological tests and autopsy, there is always a risk of exogenous deaths being misdiagnosed as endogenous deaths.

Conversely, it is relatively well known in forensic field that critical complications associated with drug poisoning cases, such as methamphetamine (MA) poisoning, could sometimes cause fatal hemorrhagic deaths. However, this aspect is barely known in clinical practice. Moreover, research on fatal hemorrhage as a complication associated with MA poisoning is very limited, and studies combining autopsy and postmortem findings have not yet been published.
We therefore focused on this area, and obtained some interesting results. We recorded 16 cases of fatal hemorrhage associated with MA poisoning among 90 cases of non-traumatic fatal hemorrhage. These results indicated that few drug poisoning cases classified as fatal hemorrhage should not be considered to be endogenous deaths.

Subsequently, our research focused on fatal intracerebral hemorrhage, and its postmortem CT features indicated that younger male, remarkable mid-line shift, and less aortic valve calcification could be the key to diagnose such cases.

This research won the ISFRI Prize at the 8th International Society of Forensic Radiology and Imaging (ISFRI) held in Berlin.

Maiko Yoshida