Can post-mortem CT reliably distinguish between drowning and non-drowning asphyxiation?

Abstract

Our results indicate that it is not possible to reliably distinguish drowning from non-drowning asphyxiation on CT, because many findings in drowning were also present in non-drowning asphyxiation. CT indicators for drowning as the cause of death should therefore be defined with great caution, keeping in mind that they are not specific to only a single cause of death.

Post-mortem evaluation of drowning with whole body CT

“…The results of our study using computed tomography to investigate drowning cases confirm the presence of fluid in sinuses and trachea, which is in accordance with literature findings [3,6,9,11,18]. None of the control cases had fluid in the paranasal sinuses or trachea, which can be explained by the fact that in hanging victims there is no exposure to water.…”

“…Pleural effusions were found in approximately 70% of drowning subjects [3,11]. The position of the diaphragmatic dome of drowning subjects is at an average level of the fifth anterior rib, which is lower than in control groups, [3,18].…”

“…In maxillary and sphenoidal sinuses, fluid was present in up to 100% of the drowning cases, in the frontal sinus in 70% to 100% and 80% to 100% had ethmoidal fluid [3,11]. In the paranasal sinuses of eleven deaths by asphyxiation (by another manner than submersion in liquid), fluid was present in 78% [18]. Levy et al found fluid in mastoid air cells in 100% of drowning victims [11].…”

“…In the lungs the most common finding was the presence of ground glass opacities (GGO), in a mosaic pattern of hypoperfused and hyperperfused lung areas [3,9,11,18]. Pleural effusions were found in approximately 70% of drowning subjects [3,11].…”

“…When the density of cardiac chambers was measured, some studies found a lower density, others found a higher density than in their control group [1,3,18]. In drowning victims the average density of the stomach content was 20 Hounsfield units (HU) and up to 90% had a duodenal distension [3].…”