Contribution of computed tomography in the postmortem diagnosis of drowning: a systematic review

The postmortem diagnosis of drowning is a challenge for forensic medicine. The objective of this review was to list the findings described in reports of postmortem computed tomography (PMCT) examinations and autopsies of drowning victims, as well as to show how PMCT facilitates the diagnosis. The PubMed, Google Scholar, the Brazilian Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Office for the Advancement of Higher Education) Journals, and the International Prospective Register of Systematic Reviews (PROSPERO) databases were searched. The 17 studies included evaluated a collective total of 726 bodies of drowning victims and 477 bodies of people who died from other causes. Different PMCT protocols were used, some encompassing whole-body scans and others including scans only from the skull to the pelvis, with different slice thicknesses, all without the use of contrast. The finding most commonly described was fluid in the paranasal sinuses, mastoid air cells, and airways, referred to as specific for drowning if frothy, containing dense sediment, or both. A cutoff of 37.77 HU for the density of fluid in the paranasal sinuses was suggested to characterize drowning in salt water. Paltauf spots were detected only at autopsy. Although PMCT has proven to be a useful tool in making this diagnosis, it is too early to predict whether it can replace conventional autopsy. Current limitations include the absence of established protocols, a shortage of forensic radiologists, and low availability of CT scanners at forensic medicine facilities.