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

Purpose: The aim of this study is to evaluate whether previously reported post-mortem CT findings in drowning can reliably distinguish drowning from asphyxiation by any other manner.

Materials and methods: Cases (n = 14) were corpses with cause of death determined as drowning by concordant autopsy findings and physical and circumstantial evidence. Controls (n = 11) were corpses in which the cause of death was defined as asphyxiation by any other manner than submersion in a liquid. Images were evaluated for the presence of fluid in paranasal sinuses, mastoid air cells and lower airways, frothy foam in the upper airways, ground-glass opacity of the lung parenchyma, the height of the right hemi-diaphragm, the interpulmonary distance at the level of the aortic valve, the mean density of intracardiac blood, and gastric and esophageal contents. Descriptive statistics, Fisher’s exact test, and Student’s t test were used when appropriate.

Results: Only the height of the right hemi-diaphragm differed significantly (p = 0.045) between cases (mean 5.4) and controls (mean 4.3). Other findings were not significantly different between both groups.

Conclusion: 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.