CASE
An unresponsive 49-year-old male with pinpoint pupils was found in the international arrivals terminal at the airport. The paramedics noted a white powdery substance around his mouth and nostrils. The patient awoke after being given naloxone for suspected heroin overdose. By the time he was transported to the emergency department (ED), he was alert and oriented. Examination revealed tachycardia and hypoxia. Although the patient was a poor historian, he admitted that he had snorted cocaine before boarding the airplane and had used heroin during the flight. His urinary toxicology was positive for opiates. A plain radiograph of his abdomen was obtained (Figure 1). What does the image reveal?
