Eur Radiol DOI 10.1007/s00330-007-0745-4 FORENSIC MEDICINE Andreas Christe Emin Aghayev Christian Jackowski Michael J. Thali Peter Vock Received: 20 February 2007 Revised: 29 June 2007 Accepted: 20 July 2007 # Springer-Verlag 2007 Drowning—post-mortem imaging findings by computed tomography Abstract The aim of this study was to identify the classic autopsy signs of drowning in post-mortem multislice computed tomography (MSCT). Therefore, the post-mortem pre- autopsy MSCT- findings of ten drowning cases were correlated with autopsy and statistically compared with the post-mortem MSCT of 20 non-drowning cases. Fluid in the air- ways was present in all drowning cases. Central aspiration in either the trachea or the main bronchi was usually observed. Consecutive bron- chospasm caused emphysema aquo- sum. Sixty percent of drowning cases showed a mosaic pattern of the lung parenchyma due to regions of hypo- and hyperperfused lung areas of aspi- ration. The resorption of fresh water in the lung resulted in hypodensity of the blood representing haemodilution and possible heart failure. Swallowed water distended the stomach and du- odenum; and inflow of water filled the paranasal sinuses (100%). All the typical findings of drowning, except Paltau’ s spots, were detected using post-mortem MSCT, and a good cor- relation of MSCT and autopsy was found. The advantage of MSCT was the direct detection of bronchospasm, haemodilution and water in the para- nasal sinus, which is rather compli- cated or impossible at the classical autopsy. Keywords Virtopsy . Drowning . Post-mortem . Multislice computed tomography Introduction A generally used definition of drowning is given by Roll [1]: “Death by drowning is the result of a hampering of respiration by obstruction of mouth and nose by a fluid medium (usually water)”. Generally, bodies retrieved from water may have: (1) died of natural disease before falling into the water, (2) died of natural disease while already in the water, (3) died from injury before being thrown into the water, (4) died of injury while in the water, (5) died of effects of immersion other than drowning, (6) died of drowning (true drowning). According to the World Health Organisation, the annual worldwide incidence of death by drowning is about 400,000 [2]. Death from drowning is more common in young children [3]. In adults, suicide is a frequent cause of drowning, which is often associated with past psychiatric history [4]. Drowning has especially been related to young adults who are under the influence of alcohol and other drugs whilst being near water [5, 6]. The pathophysiological aspects of drowning are complex. Ten percent of drownings happen without aspiration of fluid in the lung [7, 8]; this is the so-called “dry drowning” due to a laryngospasm because of hypoxia and stimulus of water in the upper respiratory ways (larynx) [9, 10]. The remaining 90% of drownings are so-called “wet drown- ing”: the volume and composition of aspirated fluid determine the physiological basis of hypoxemia [11–13]. Aspiration of fresh water dilutes the pulmonary surfactant and makes alveoli unstable [14], which leads to the collapse and atelectasis of some of the alveoli. Intrapul- monary shunt occurs with considerable pulmonary venous admixture [15]. The appearance of hypotonic fresh water in the alveoli is not usually a problem, because it is rapidly absorbed into the pulmonary and systemic circulation with A. Christe (*) . P. Vock Institute of Diagnostic Radiology, University Hospital, Freiburgstrasse, 3010 Bern, Switzerland e-mail: andreas.christe@insel.ch Tel.: +41-31-6322111 Fax: +41-31-6323224 A. Christe . E. Aghayev . C. Jackowski . M. J. Thali Center Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012 Bern, Switzerland