What are the findings of the post-mortem report for a previously healthy 36-year-old male who died from drowning in a river?

Post-Mortem Report: 36-Year-Old Male Drowning Victim

A comprehensive post-mortem examination of a drowning victim should document scene circumstances, external and internal findings, histological evidence, and ancillary testing to establish drowning as the cause of death, while excluding other contributing factors.

Scene Investigation and Circumstances

Document the following critical scene information:

• Time face was first seen underwater and time removed from water to establish submersion duration, which is the most important predictor of outcome and helps confirm the drowning process 1
• Water temperature (core data requirement), as this may influence physiological findings and should be recorded 1
• Type of water/liquid (freshwater river in this case), as heavily contaminated water may result in additional complications such as infection and pneumonitis 1
• Witness statements regarding the victim's behavior before submersion, any struggle observed, and estimated time intervals 1
• Presence of alcohol, drugs, or evidence of trauma at the scene, as these may represent precipitating events 2

External Examination Findings

Classic external findings in drowning include:

• Cutis anserina (goosebumps) on the skin surface, indicating the body was in water 2
• Washerwoman skin (wrinkling of palms and soles) after prolonged immersion 2
• Frothy foam in the mouth and nostrils (if present)
• Absence of significant trauma unless there are specific circumstances suggesting injury occurred before or during drowning 3
• Lividity pattern consistent with body position in water
• Body temperature and degree of rigor mortis

Internal Examination Findings

Respiratory System

The lungs are the most critical organs for drowning diagnosis:

• Emphysema aquosum (overinflation of lungs with a mosaic pattern of lung parenchyma) 4
• Pulmonary congestion, edema, and hemorrhage on histological examination 5, 4
• Paltauf spots (subpleural hemorrhages) detected on careful examination 4
• Fluid in the airways (paranasal sinuses, upper and lower airways) 4
• Ground-glass opacity of lung parenchyma on imaging if available 6

Important caveat: These pulmonary findings are relatively nonspecific for drowning and can occur in other forms of asphyxia 7, 6. The upper lobe findings may be most important for differentiating drowning from other asphyxia 5.

Cardiovascular System

• Dilated right side of the heart may be observed 2
• Intracardiac blood density should be documented if CT imaging is performed 6
• Exclude cardiac pathology (coronary artery disease, cardiomyopathy) that could have precipitated the drowning

Gastrointestinal System

• Fluid in the stomach and duodenum is commonly present 4
• Gastric and esophageal contents should be documented 6

Other Organ Systems

• Congestion in multiple organs including liver, spleen, and kidneys on histological examination 4
• Exclude preexisting medical conditions (seizure disorder, cardiac disease) that may have contributed 2

Histological Examination

Both upper and lower lung lobes should be examined histologically:

• Hematoxylin and eosin (H&E) staining to assess congestion, hemorrhage, and edema 5
• Immunohistochemical surfactant protein A (SP-A) expression in both lung lobes, as the presence and severity may help differentiate drowning from other asphyxia and other causes of death 5
• Samples from liver, spleen, kidneys to document multi-organ congestion 4

Ancillary Testing

Diatom Analysis

Diatom testing is a critical ancillary test:

• Collect lung tissue samples for diatom examination 4
• Compare diatom morphology in lung tissues with water samples from the drowning scene 4
• Identical diatom morphology between lung tissue and scene water strongly supports drowning as the cause of death 4

Toxicology

• Comprehensive toxicology screening for alcohol, drugs, and medications that may have impaired the victim or precipitated the drowning 2
• Blood alcohol concentration and drug levels should be quantified

Postmortem Imaging (If Available)

Postmortem CT can provide valuable supplementary information:

• Fluid in paranasal sinuses, mastoid air cells, and airways 4, 6
• Emphysema aquosum and mosaic lung pattern 4
• Height of right hemidiaphragm (may be elevated compared to non-drowning asphyxiation) 6

Critical limitation: CT findings alone cannot reliably distinguish drowning from other forms of asphyxiation, as many findings overlap 6. CT should supplement, not replace, conventional autopsy.

Cause of Death Determination

The final determination should state:

• Primary cause of death: Drowning (defined as a process resulting in primary respiratory impairment from submersion in a liquid medium) 1
• Contributing factors: Document any precipitating events such as alcohol intoxication, drug use, seizure, syncope, cardiac events, or trauma 2
• Manner of death: Accident, suicide, homicide, or undetermined based on scene investigation and autopsy findings 1

Common Pitfalls to Avoid

• Do not rely solely on imaging findings without histological confirmation, as CT cannot reliably distinguish drowning from other asphyxiation 6
• Do not assume drowning based on body recovery location alone—comprehensive investigation is required 7
• Do not overlook precipitating medical conditions or toxicology that may have caused the victim to enter the water 2
• Examine both lung lobes histologically, as upper lobe findings may be most diagnostic 5
• Recognize that many drowning findings lack specificity and the diagnosis requires correlation of scene investigation, autopsy findings, histology, and ancillary testing 7