What are the typical CT (Computed Tomography) chest findings in a patient who has experienced drowning?

CT Chest Findings in Drowning

The typical CT chest findings in drowning patients include bilateral patchy or diffuse areas of ground-glass opacities, often with a geographic pattern, interlobular septal thickening, and ill-defined centrilobular nodules. 1, 2

Primary Pulmonary Findings

• Ground-glass opacities with or without associated reticular opacities ("crazy-paving" appearance) are the most consistent findings, typically with central or diffuse distribution 1, 3
• Interlobular septal thickening is frequently observed, creating a mosaic pattern appearance 2, 4
• Ill-defined centrilobular nodules along the airways are present in many cases 1, 3
• Peribronchal cuffing and perivascular nodular ground-glass opacities may be visible 2
• Air-space consolidation can occur but is less common than ground-glass opacities 1

Additional CT Findings

• Fluid and/or sediment in the paranasal sinuses and airways (subglottic trachea and main bronchi) is highly suggestive of drowning 4, 5
• Frothy fluid in the airways may be present in approximately 21% of drowning cases 4
• Mastoid air cell fluid is commonly observed 4, 5
• Interstitial pulmonary emphysema and pneumomediastinum may be present in some cases 1

Distribution Patterns

• Ground-glass opacities typically show one of three distribution patterns:
  • Predominantly central distribution (most common) 1
  • Diffuse distribution throughout both lungs 1, 3
  • Posterior and basilar predominance (less common) 4

Extrapulmonary Findings

• Pleural fluid is present in approximately 71% of drowning cases 5
• Pericardial fluid is observed in about 59% of drowning victims 5
• Esophageal fluid (81%), stomach distension with fluid (71%), and duodenal/jejunal distension may be present 5
• In freshwater drowning, hemodilution may be detected as lower density in the spleen 5

Diagnostic Significance

• The combination of frothy airway fluid and high-attenuation airway sediment is highly specific for drowning 4
• The triad of pan-sinus fluid, mastoid cell fluid, and subglottic tracheal/bronchial fluid strongly supports drowning in the appropriate clinical context 4
• CT findings must be interpreted in conjunction with clinical history, as some findings may overlap with other conditions causing pulmonary edema 2

Clinical Implications

• CT findings can help distinguish between drowning and other causes of death, particularly in forensic cases 4, 5
• The pattern and severity of lung findings may correlate with the duration of submersion and survival time after rescue 1, 2
• Understanding these imaging patterns is crucial for radiologists interpreting chest CTs in near-drowning survivors 2