ARRS: CT findings illuminate effects of adulterated cannabinoids

Particular CT imaging findings can help clinicians diagnose negative effects of the use of adulterated cannabinoids, according to research presented at the American Roentgen Ray Society (ARRS) annual meeting.

A team led by Nitai Bar, MD, of Rambam Healthcare Campus in Haifa, Israel, reported that suburothelial hemorrhage and intramural bowel hematomas found on CT imaging were indicative of coagulopathy linked to contaminated cannabinoids such as THC (tetrahydrocannabinol), CBD (cannabidiol), CBG (cannagigerol), CBN (cannabinol), and CBC (cannabichromene).

"CT plays a key role in the diagnosis and work-up of adulterated cannabinoid-associated coagulopathy," the group wrote.

Severe coagulopathy due to intake of synthetic cannabinoids that have been cut with brodifacoum, a long-acting anticoagulant, is an increasing hazard with potential life-threatening consequences, Bar and colleagues explained. The team reviewed CT imaging findings that indicated coagulopathy due to adulterated cannabinoid poisoning from 48 patients included in the Israeli Poison Information Center database; the individuals presented at the Rambam Health Care Campus between September 2021 and June 2022.

There were 54 hospitalizations among the 48 patients. Bar's group found the following:

• 93% of cases showed symptomatic hemorrhage at initial presentation. Most of these (78%) presented as hemorrhage from multiple systems.
• The most common bleeding site was the genitourinary system, with a typical sign of suburothelial bleeding in 16 of 18 individuals who underwent abdominal CT exams for cannabinoid-associated coagulopathy (sensitivity, 89%).
• Intramural bowel hematomas were noted in 70% of CTs in patients with gastrointestinal bleeding. Incidental bleeding sites were identified on imaging in 24% of patients, including pseudoaneurysm and retroperitoneal hemorrhage.

"Recognition of radiological signs of adulterated synthetic cannabinoid-associated coagulopathy is critical for optimizing outbreak control on the public health level and ensuring timely treatment on the individual patient level," the researchers concluded.