Plain abdominal X-ray film is the most common radiological method for investigating suspected body packers.
It is an easy,
quick and widely available test,
with varying but high accuracy for the detection of drug-filled packets.
On a plain abdominal radiograph the packets are usually detected as multiple,
well defined homogenous spherical or cylindrical,
radiodense packets,
but one of the most important signs is a thin,
lucent rim of air with a spherical or cylindrical pattern.
This finding is most often caused by air trapped between the wrapping and the illicit drug.
This radiological finding can also be created by a rim of air found between layers of latex when body packers use double-wrapped condoms,
this is called the “double condom sign”.
(Figs.
1,2,3,4)
However as stool may also appear somewhat spherical as well,
the radiological differences between ingested drug packets and surrounding stool may be subtle.
The high density of packet content and the dense contour of the packet’s synthetic material helps distinguish the ingested substance from normal bowel content.
The smugglers can use evasive tactics,
usually unsuccessful,
attempt to degrade the image or distract the radiologist,
in the belief that metallic embellishments in clothing,
internal metallic objects,
or other radiodense contrast material will alter the detection of foreign bodies by distorting or masking them.
Movements during the performance of the test are some techniques used to distort the image,
but the technologist must ensure the quality of examination before it is reported.
There are few reports on the use of ultrasound which is non-ionizing and has low recurring cost.
Ultrasound studies show that drug packets in the stomach are easily detected when they are surrounded by fluid.
The use of CT scan of the abdomen will increase due to the use of non-radio-opaque package materials such as condoms filled with liquid cocaine.
(Figs.
5,6,7,8,9)
Another reason for a more frequent use of CT scans is the conclusion of some studies who found a higher sensitivity and specificity of a CT scan compared to an abdominal X-ray of the abdomen for the diagnosis of bowel obstruction.
The CT scan may be performed without oral contrast,
and may show drug packages to be of slightly higher density than soft tissue,
and trapped air in condoms becomes more conspicuous.
(Figs.
10,11,12)