Exact volumetric determination of fluid in the paranasal sinuses after drowning

Lundemose, Sissel Banner; Jacobsen, Christina; Jakobsen, Louise Kollander; Lynnerup, Niels

doi:10.1016/j.jofri.2015.02.003

Cited by 12 publications

(2 citation statements)

References 14 publications

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“…This overlooks the possibility that drowning victims may experience a greater influx of fluid compared to non-drowning victims and that fluid composition may differ. Analysis of fluid density has been conducted in the literature, but reference values remain unknown due to significant variation between studies [ 37 , 43 , 44 ]. In the present study, fluid volume was measured in mm 3 and expressed as ml, suggested to be more meaningful.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Circumstantial evidence is considered crucial in such cases, because the autopsy findings classically associated with drowning often lack sensitivity and/or specificity. Findings such as marked amounts of frothy fluid in the airways, increased lung weight, water in the stomach, hemorrhage of mastoid air cells in the middle ear, increased fluid volume in the maxillary and sphenoid sinuses (“Svechnikov’s sign”), diatoms in the vasculature, hemolytic staining of the aortic intima (especially in freshwater drownings), and decreased splenic weight have each been associated with drowning but are poorly reproducible and may only prove that the body was submerged in water (in some cases postmortem) (4 –8).…”

Section: Introductionmentioning

confidence: 99%

Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Ellis¹,

Opsahl²,

Duff³

et al. 2019

Academic Forensic Pathology

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Introduction: Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many nondrowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index (DI) has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. Studies have suggested DI may be useful in confirming drowning as the cause of death. No studies have yet compared autopsy findings in drownings to those in drug-related deaths, in spite of their qualitative similarities. Materials and Methods: We compared the lung and pleural effusion weight, spleen weight, and DI from 536 autopsies ruled drowning, opioid, or multidrug intoxication, or hanging in Columbia, Missouri, from 2011 to 2016. Results: Opioid overdoses result in heavier lungs and spleens than drownings, multidrug overdoses, or hangings. There is no DI value at which a death can be definitively ascribed to drowning. The median DI was significantly higher in drownings than in opioid intoxications, multidrug intoxications, or hangings ( P < .0001; P = .001; P = .005). However, very few drowning cases (13.33%) had a DI >14.1. Additionally, many opioid and multidrug overdoses had a DI >14.1. The highest calculated DI value (DI = 33) was associated with multidrug intoxication. Conclusion: In our opinion, the DI has little, if any, utility in distinguishing between drowning and drug-related deaths.

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