Postmortem CT analysis of fluid in the paranasal sinuses following fatal heroin intoxications

• PMCT demonstrates fluid-filled paranasal sinuses in almost half of heroin intoxication fatalities • Fluid density differs by cause of death, suggesting diagnostic relevance • Control groups should be stratified in postmortem studies of paranasal sinuses • Mechanistic insight into association between heroin intoxication and fluid filled paranasal sinuses is warranted Detection of fluid in the paranasal sinuses postmortem has been primarily associated with drowning, though similar findings following other causes of death suggest broader forensic implications. This study investigates the presence, volume, and radiodensity of fluid in paranasal sinuses in three populations with different causes of death: heroin intoxication (n=32), drowning (n=44), and hanging (n=30). The primary objective is to investigate the prevalence of fluid in the maxillary and sphenoidal sinuses postmortem following heroin intoxication, and to evaluate how the characteristics of this fluid differ across groups. Postmortem computed tomography (PMCT) was used to assess sinus fluid presence and properties. Results show that 44% of heroin intoxications exhibited fluid, though volume was significantly less than that observed in drowning cases. The radiodensity of the fluid in the heroin intoxication cases was, on the other hand, significantly higher than that observed in the drowning group, suggesting a greater endogenous content compared to that identified in the drowning cases. Findings further challenge the notion that fluid in the sinuses postmortem is exclusive to drowning and highlight the need for stratification of non-drowning control groups in forensic research. This study is the first to examine paranasal sinus fluid in heroin intoxication deaths using PMCT. Findings suggest that hanging as a universal control group is not always applicable in postmortem research, and that causes of death beyond drowning may also result in fluid in the sinuses postmortem. Further research is warranted to clarify the mechanisms underlying sinus fluid in heroin and other potential opiate intoxications and hangings.