Diagnostic challenges of drowning in forensic medicine.

Death from respiratory impairment brought on by immersion or submersion in liquid is known as drowning. Even with its widespread occurrence, forensic verification of drowning is still difficult. Drowning does not exhibit pathognomonic postmortem signs, in contrast to other causes of death (1).

Emphysema aquosum, frothy fluid in the airways, Paltauf's hemorrhages, and watery stomach contents are examples of traditional autopsy indications that have low specificity and can show up in non-drowning deaths. Interpretation is further complicated by postmortem artifacts, environmental influences, and decomposition (2).

Recent studies investigate biomarkers such inflammatory mediators, aquaporins, and microRNAs. PMCT has also demonstrated potential in the detection of sinus opacification and fluid distribution patterns (3). The purpose of this study is to examine the diagnostic difficulties that were faced in 80 past cases of suspected drowning in light of these uncertainty.

Study Design

Retrospective descriptive study conducted at PRM Medical College & Hospital, , Baripada and SJ Medical College & Hospital, Puri, Odisha.

Study Population

80 medico-legal autopsies of suspected drowning conducted in the year January 2023 to December 2024.

Inclusion Criteria

•              Bodies recovered from water

•              Suspicion of drowning based on scene investigation

Exclusion Criteria

•              Advanced decomposition precluding evaluation

•              Severe traumatic injuries incompatible with life

Data Collection

The following parameters were reviewed:

1.             Demographics (age, sex)

2.             Circumstances and scene findings

3.             External and internal autopsy findings

4.             Histopathological examination

5.             Diatom testing (when performed)

6.             Toxicological analysis

7.             Radiological imaging (PMCT when available)

Statistical Analysis

To compare suspected and confirmed instances, descriptive statistics were used, including cross-tabulation and percentage distribution.

Demographics

·         Males: 56 (70%)

·         Females: 24 (30%)

·         Age range: 4–78 years

·         Most affected age group: 21–40 years

Table 1: Frequency of autopsy findings

No single finding demonstrated absolute diagnostic value.

Table 2: Type of Water Body Involved

Table 3: Internal Organ Weights (Mean ± SD)

Table 4: Histopathological Findings

The present retrospective analysis of 80 autopsy-confirmed drowning cases highlights important autopsy findings, type of water body involved, internal organ weights, histopathological findings, all of which collectively underscore the persistent diagnostic challenges in forensic drowning (4).

Although they were commonly seen, traditional findings including Paltauf's spots (48.7%), fine froth in airways (67.5%), and overinflated lungs (82.5%) lacked specificity. The highest rate of river drowning was 36.25%, followed by 26.2%. The majority of emphysema aquosum and histological characteristics were detected in 78.7% of cases.

Histopathology predominantly demonstrated alveolar edema, intra-alveolar hemorrhage, and features consistent with emphysema aquosum (5). These changes result from water aspiration, surfactant destruction, and hypoxic injury. Intra-alveolar hemorrhage observed in several cases may result from increased intrathoracic pressure during respiratory struggle (6). Nonetheless, similar findings can occur in mechanical asphyxia and trauma. Therefore, microscopic findings must be interpreted cautiously and in conjunction with toxicology and diatom analysis (7).

This study reaffirms that drowning remains one of the most challenging causes of death to diagnose in forensic medicine, requiring careful integration of epidemiological context, autopsy findings, histopathology, and ancillary testing. The high frequency of pulmonary edema, increased lung weight, and emphysema aquosum aligns with established literature; however, their lack of specificity necessitates correlation with investigative, toxicological, and laboratory data.

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3.       Farrugia A, Ludes B. Diagnostic of Drowning in Forensic Medicine. intechopen. 2011;(september):53–60.

4.       Saritha Ebeneezar PV and T. P. ORGAN WEIGHT VARIATIONS IN CASES OF DROWNING IN FRESH WATER IN COMPARISION WITH NON-DROWNING DEATHS. Int J Adv Res. 2024;12(08):1047–53.

5.       Dahiya P, Bhatia A, Khatri S. Forensic Diagnosis of Drowning in Animals : A Critical Review of Diagnostic Modalities and the Efficacy of the Diatom Test in Veterinary Medicine. Perspect Leg Forensic Sci 2025,. 2025;2(10012):1–10.

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