Window manipulation in diagnosis of body packing using computed tomography

Body packing refers to the internal concealment of narcotics, usually within the gastrointestinal tract. This is important to recognise for clinical and forensic reasons. Imaging is often helpful, particularly because an accurate history is unusual. Furthermore, clinical examination and urine screens are often unreliable. Plain abdominal radiography and ultrasonography have been used with limited success. Thus, the use of alternative modalities, such as computed tomography (CT), is becoming more widespread. Although there have been no large trials, one false-negative has been reported. We report the case of a body packer whose CT appeared normal with standard abdominal windowing (level 40/width 400). However, on manipulation of the windowing (level -175/width 600), paraffin and heroin packages became conspicuous within the colon. We suggest that the simple step of reviewing images on wider than standard abdominal windows may be helpful in the detection of ingested illicit packages of fatty density within the bowel.