A comparative digital morphometric study of lung tissue in saltwater and freshwater drowning

Barranco, Rosario; Castiglioni, Claudia; Ventura, Francesco; Fracasso, Tony

doi:10.1016/j.forsciint.2019.03.004

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…Although some pathological changes have been described in drowning as emphysematous-like alveolar patterns or “emphysema aquosum” [ 12 , 44 , 45 ], other authors believe that there are no specific histological changes [ 23 , 46 ]. Recent studies suggest that acute pulmonary emphysema is not a typical sign of death by saltwater drowning [ 37 ]. Conversely, in the PBt/AGE group, our results show an emphysematous pattern that is different from the other analysed groups and congruent with bronchoalveolar emphysema.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have used experimental models that induce PBt in animals, commonly rabbits, in hyperbaric chambers [ 35 ]. Recently, a histomorphometric analysis of pulmonary tissue has been proposed as a technique for providing objective data on alveolar distension in cases of asphyxia in humans [ 36 , 37 ]. However, to date, there are no studies using quantitative techniques to investigate the presence of air in the lungs in cases of PBt.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis

Casadesús

Nieto‐Moragas

Serrando

et al. 2023

Forensic Sci Med Pathol

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Arterial gas embolism following pulmonary barotrauma occurs in 13–24% of cases of diving deaths. The study aimed to evaluate the usefulness of a histomorphometric digital analysis in the detection of air space over-distension due to pulmonary barotrauma. The study was performed on lung parenchyma specimens of 12 divers: six had died due to arterial gas embolism following pulmonary barotrauma (mean age at death of 54 years, range of 41–61 years), and six had drowned in saltwater without a diagnosis of pulmonary barotrauma (mean age at death of 54 years, range of 41–66 years) (positive controls). For negative controls, six cases of non-SCUBA divers (mean age of death of 42 years, range of 23–55 years) who died of intracerebral haemorrhage were evaluated. No significant differences were observed in the characteristics of the air spaces between control groups (positive and negative). However, differences were observed in the area occupied by air spaces and the percentage of air space area when we compared the case group to the controls (p < 0.01); and there was a slight difference in the maximum and minimum diameters of air space (p < 0.05). The mean area occupied by air spaces and the mean percentage of air space were the most useful for discriminating pulmonary barotrauma from other causes of death (100% sensitivity and 91.7% specificity). Based on our study, inclusion of an increased pattern of air spaces as a possible diagnostic criterion for pulmonary barotrauma would be useful in discerning the cause of diving death.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis

Casadesús

Nieto‐Moragas

Serrando

et al. 2023

Forensic Sci Med Pathol

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“…To determine drowning as a cause of death, an array of pathological indicators may be examined during autopsy. This includes macroscopic findings, such as foam in the respiratory tract [ 2 – 5 ], pulmonary edema and pulmonary emphysema [ 6 – 8 ], that may also be examined microscopically [ 9 – 11 ]. However, none of these traits are pathognomonic for drowning [ 12 ], and nor do all individuals presumed to have drowned exhibit all or any of the pathologies, rendering them unreliable.…”

Section: Introductionmentioning

confidence: 99%

Postmortem CT analysis of paranasal sinuses using an experimental model of drowning

Tyr,

Zilg,

Gelius

et al. 2024

Int J Legal Med

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Fluid-filled paranasal sinuses are suggested to be a valuable tool to distinguish between drowning and non-drowning postmortem, yet the mechanisms governing fluid entry remains unknown. We investigate if fluid-filled paranasal sinuses are caused by a passive influx from submersion or an active aspiration mechanism during drowning. The ovine nasal cavity and maxillary sinuses are remarkably similar anatomically to humans, and have been used for endoscopic surgical training in recent decades. We submerged 15 decapitated ovine heads from agricultural waste at a depth of 2 m in flowing water for 1, 8, and 24 h and 7 days. Paranasal sinuses were CT imaged and compared pre- and post-submersion to non-submerged controls. Furthermore, we examined the paranasal sinuses of a single homicide case of a non-drowned submerged subject. Results demonstrate that fluid passively enters the maxillary sinus postmortem in the non-drowned ovine heads following 1 h of submersion. Fluid volume was independent of submersion time and influenced by time out of water as well as handling, since volume was reduced between consecutive CT scans. In contrast to our hypothesis, the filling of the paranasal sinuses is due to passive influx of fluid from submersion rather than an active aspiration during drowning. The observation that paranasal sinuses were fluid-filled in a single medico-legal case of postmortem submersion supports the finding of passive influx. Consequently, careful interpretation of fluid-filled paranasal sinuses is required when bodies are found in water, as the finding cannot distinguish between postmortem submersion and drowning.

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“…Recent studies in biochemistry, histology and immunohistochemistry have provided very interesting results on the post-mortem diagnosis of drowning, complementing classical autopsy findings. For instance, useful methods for differential diagnosis between freshwater and saltwater drowning have been reported [ 10 , 11 , 12 , 13 , 14 ]. Novel technologies such as proteomics are still in the stage of exploration in forensic pathology [ 15 ], and mainly focused to determine PMI [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Proteomics in Deaths by Drowning: Diagnostic Efficacy of Apolipoprotein A1 and α-1 Antitrypsin, Pilot Study

et al. 2020

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Drowning is one of the leading causes of death worldwide. The pathophysiology of drowning is complex and, sometimes, interpretation of the circumstances of death in the autopsy becomes the main source of information in its diagnosis. New advances in medical research, such as proteomics, especially in forensic pathology, are still in the development. We proposed to investigate the application of Mass Spectrometry-based technologies, to identify differentially expressed proteins that may act as potential biomarkers in the postmortem diagnosis of drowning. We performed a pilot proteomic experiment with the inclusion of two drowned and two control forensic cases. After applying restrictive parameters, we identified apolipoprotein A1 (ApoA1) and α-1 antitrypsin as differentially expressed between the two diagnostic groups. A validation experiment, with the determination of both proteins in 25 forensic cases (16 drowned and 9 controls) was performed, and we corroborated ApoA1 higher values in the drowning group, whereas α-1 antitrypsin showed lower levels. After adjusting by confounder factors, both remained as predictive independent factors for diagnosis of drowning (p = 0.010 and p = 0.022, respectively). We constructed ROC curves for biomarkers’ levels attending at the origin of death and established an ApoA1 cut-off point of 100 mg/dL. Correct classification based on the diagnosis criteria was reached for 73.9% of the cases in a discriminant analysis. We propose apolipoprotein A1 (with our cutoff value for correct classification) and α-1 antitrypsin as valuable biomarkers of drowning. Our study, based on forensic cases, reveals our proteomic approach as a new complementary tool in the forensic diagnosis of drowning and, perhaps, in clinical future implications in drowned patients. However, this is a pilot approach, and future studies are necessary to consolidate our promising preliminary data.

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A comparative digital morphometric study of lung tissue in saltwater and freshwater drowning

Cited by 10 publications

References 18 publications

Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis

Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis

Postmortem CT analysis of paranasal sinuses using an experimental model of drowning

Proteomics in Deaths by Drowning: Diagnostic Efficacy of Apolipoprotein A1 and α-1 Antitrypsin, Pilot Study

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