Advertisement

Learning from the living to diagnose the dead – parallels between CT findings after survived drowning and fatal drowning

  • Cynthia Hourscht
  • Andreas Christe
  • Shane Diers
  • Michael J. Thali
  • Thomas D. RuderEmail author
Case Report

Abstract

A case of survived drowning is presented where CT findings of the lungs were in keeping with several findings seen on post-mortem CT (PMCT) examination after fatal drowning. These findings include interlobular septal thickening, peribronichal cuffing, mosaic pattern ground glass opacities, and perivascular nodular ground glass opacities. The absence of confounding normal post-mortem changes allows for a discussion on subtle differences between findings related to aspiration and pulmonary edema after drowning. This case represents a learning opportunity for radiologists and pathologists challenged by the complex lung findings after drowning on PMCT.

Keywords

Forensic radiology Computed tomography Drowning Aspiration Edema 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Ethical approval

Approval by Ethical Committee is not required for case reports as single case descriptions do not fulfil the criteria of research as defined by the Human Research Act.

Informed consent

Patient information has been withheld and case details have been slightly modified (without changing their significance to the case report) to protect patient anonymity.

References

  1. 1.
    Christe A, Aghayev E, Jackowski C, Thali MJ, Vock P. Drowning--post-mortem imaging findings by computed tomography. Eur Radiol. 2008;18:283–90.CrossRefGoogle Scholar
  2. 2.
    Usui A, Kawasumi Y, Funayama M, Saito H. Post-mortem lung features in drowning cases on computer tomography. Jpn J Radiol. 2014;32:414–20.CrossRefGoogle Scholar
  3. 3.
    Plaetsen S, Letter E, Piette M, Parys G, Casselman J, Verstraete K. Post-mortem evaluation of drowning with whole body CT. Forensic Sci Int. 2015;249:35–41.CrossRefGoogle Scholar
  4. 4.
    Ruder TD. On radio-morphologic correlation of post-mortem findings in human lungs in forensic medicine. Doctoral thesis. Bern: University of Bern; 2004.Google Scholar
  5. 5.
    Germerott T, Preiss US, Ebert LC, Ruder TD, Ross S, Flach PM, et al. A new approach in virtopsy: post-mortem ventilation in multislice computed tomography. Leg Med (Tokyo). 2010;12:276–9.CrossRefGoogle Scholar
  6. 6.
    Christe A, Flach P, Ross S, Spendlove D, Bolliger S, Vock P, et al. Clinical radiology and postmortem imaging (Virtopsy) are not the same: specific and unspecific postmortem signs. Leg Med (Tokyo). 2010;12:215–22.CrossRefGoogle Scholar
  7. 7.
    Sutherland T, O'Donnell C. The artefacts of death: CT post-mortem findings. J Med Imaging Radiat Oncol. 2018;62:203–10.CrossRefGoogle Scholar
  8. 8.
    Burke M, OʼDonnell C. Postmortem computed tomography findings in ruptured splenic artery aneurysm: value of the clinical "sentinel clot" sign in identification of bleeding location. Am J Forensic Med Pathol. 2015;36:224–6.CrossRefGoogle Scholar
  9. 9.
    Ruder TD, Schweitzer W, Ampanozi G, Gascho D, Flach PM, Thali MJ, et al. Imaging findings of diabetes on post-mortem CT. J Forens Radiol Imag. 2018;13:27–41.CrossRefGoogle Scholar
  10. 10.
    Olshaker JS. Submersion. Emerg Med Clin North Am. 2004;22:357–67.CrossRefGoogle Scholar
  11. 11.
    Gluecker T, Capasso P, Schnyder P, Gudinchet F, Schaller MD, Revelly JP, et al. Clinical and radiologic features of pulmonary edema. Radiographics. 1999;19:1507–31.CrossRefGoogle Scholar
  12. 12.
    Kim KI, Lee KN, Tomiyama N, Johkoh T, Ichikado K, Kim CW, et al. Near drowning: thin-section CT findings in six patients. J Comput Assist Tomogr. 2000;24:562–6.CrossRefGoogle Scholar
  13. 13.
    Orlowski JP. Drowning, near-drowning and ice-water submersion. Pediatr Clin N Am. 1987;34:75–92.CrossRefGoogle Scholar
  14. 14.
    Luijkx T, Weerakkody Y. Near drowning pulmonary oedema. Radiopaedia https://radiopaedia.org/articles/near-drowning-pulmonary-oedema. Accessed 19 Sept 2018.
  15. 15.
    Knipe H, Weerakkody H. Peribronchial cuffing. Radiopaedia. https://radiopaedia.org/articles/peribronchial-cuffing-1. Accessed 21 Dec 2018.
  16. 16.
    Bramson RT, Griscom NT, Cleveland RH. Interpretation of chest radiographs in infants with cough and fever. Radiology. 2005;236:22–9.CrossRefGoogle Scholar
  17. 17.
    Rumbak M. The etiology of pulmonary edema in fresh water near-drowning. Am J Emerg Med. 1996;4:176–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Diagnostic, Interventional, and Pediatric RadiologyUniversity Hospital BernBernSwitzerland
  2. 2.Department of RadiologyTiefenauspitalBernSwitzerland
  3. 3.Department of Radiology, Northland District Health BoardWhangarei HospitalWhangareiNew Zealand
  4. 4.Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland

Personalised recommendations