Heroin Body Packing: Clearly Discerning Drug Packets Using CT

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.