Virtual Autopsy: Two- and Three-dimensional Multidetector CT Findings in Drowning with Autopsy Comparison1

Abstract

To retrospectively determine the multidetector computed tomographic (CT) virtual autopsy findings of death by drowning in comparison with autopsy findings. The institutional review board of the Armed Forces Institute of Pathology approved this HIPAA-compliant study and did not require informed consent by the next of kin. Total-body multidetector CT was performed, immediately prior to routine autopsy, in 28 consecutive male subjects (mean age, 24.2 years) who died of drowning and a control group of 12 consecutive male subjects (mean age, 50.8 years) who died of sudden death from atherosclerotic coronary artery disease. Images were evaluated for the presence of fluid and sediment in the paranasal sinuses and airways, mastoid air cell fluid, frothy fluid in the airways, pulmonary opacity (ground-glass opacity or airspace consolidation), interlobular septal thickening, and gastric distention and contents (fluid or sediment). Image findings were compared with findings from autopsy reports and photographs. All drowning subjects had fluid in the paranasal sinuses and mastoid air cells and had ground-glass opacity within the lungs. Twenty-six subjects (93%) had fluid in the subglottic trachea and main bronchi. Fourteen subjects (50%) had high-attenuation sediment in the subglottic airways. Frothy fluid in the airways was present in six subjects (21%). Twenty-five (89%) of the drowning subjects had pulmonary ground-glass opacity with septal lines, which was mild with apical and perihilar distribution in 12 subjects, severe and diffuse in nine, posterior and basilar in three, and limited to the apices in one (not assessed in three of 28 subjects because of decomposition). Control subjects showed mastoid cell fluid (25%), sinus fluid (83%), subglottic airway fluid (92%), and pulmonary ground-glass opacity (100%) but did not have evidence of frothy airway fluid or high-attenuation sediment in the airways. The multidetector CT finding of frothy airway fluid or high-attenuation airway sediment is highly suggestive of drowning; multidetector CT findings of pan sinus fluid, mastoid cell fluid, subglottic tracheal and bronchial fluid, and ground-glass opacity within the lung at multidetector CT are supportive of drowning in the appropriate scenario.