Levy Angela D, Harcke H Theodore, Getz John M, Mallak Craig T, Caruso James L, Pearse Lisa, Frazier Aletta A, Galvin Jeffrey R
Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Radiology. 2007 Jun;243(3):862-8. doi: 10.1148/radiol.2433061009.
To retrospectively determine the multidetector computed tomographic (CT) virtual autopsy findings of death by drowning in comparison with autopsy findings.
The institutional review board of the Armed Forces Institute of Pathology approved this HIPAA-compliant study and did not require informed consent by the next of kin. Total-body multidetector CT was performed, immediately prior to routine autopsy, in 28 consecutive male subjects (mean age, 24.2 years) who died of drowning and a control group of 12 consecutive male subjects (mean age, 50.8 years) who died of sudden death from atherosclerotic coronary artery disease. Images were evaluated for the presence of fluid and sediment in the paranasal sinuses and airways, mastoid air cell fluid, frothy fluid in the airways, pulmonary opacity (ground-glass opacity or airspace consolidation), interlobular septal thickening, and gastric distention and contents (fluid or sediment). Image findings were compared with findings from autopsy reports and photographs.
All drowning subjects had fluid in the paranasal sinuses and mastoid air cells and had ground-glass opacity within the lungs. Twenty-six subjects (93%) had fluid in the subglottic trachea and main bronchi. Fourteen subjects (50%) had high-attenuation sediment in the subglottic airways. Frothy fluid in the airways was present in six subjects (21%). Twenty-five (89%) of the drowning subjects had pulmonary ground-glass opacity with septal lines, which was mild with apical and perihilar distribution in 12 subjects, severe and diffuse in nine, posterior and basilar in three, and limited to the apices in one (not assessed in three of 28 subjects because of decomposition). Control subjects showed mastoid cell fluid (25%), sinus fluid (83%), subglottic airway fluid (92%), and pulmonary ground-glass opacity (100%) but did not have evidence of frothy airway fluid or high-attenuation sediment in the airways.
The multidetector CT finding of frothy airway fluid or high-attenuation airway sediment is highly suggestive of drowning; multidetector CT findings of pan sinus fluid, mastoid cell fluid, subglottic tracheal and bronchial fluid, and ground-glass opacity within the lung at multidetector CT are supportive of drowning in the appropriate scenario.
回顾性确定多排螺旋计算机断层扫描（CT）虚拟尸检中溺水死亡的结果，并与尸检结果进行比较。
武装部队病理研究所的机构审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的研究，且无需近亲的知情同意。在28例连续的溺水死亡男性受试者（平均年龄24.2岁）以及12例连续的因动脉粥样硬化性冠状动脉疾病猝死的男性受试者（平均年龄50.8岁）中，于常规尸检前即刻进行了全身多排螺旋CT检查。对图像进行评估，观察鼻窦和气道内是否存在液体和沉积物、乳突气房积液、气道内泡沫状液体、肺部实变（磨玻璃样实变或肺泡实变）、小叶间隔增厚以及胃扩张和内容物（液体或沉积物）情况。将图像结果与尸检报告及照片结果进行比较。
所有溺水受试者鼻窦和乳突气房内均有液体，肺部有磨玻璃样实变。26例受试者（93%）声门下气管和主支气管内有液体。14例受试者（50%）声门下气道内有高密度沉积物。6例受试者（21%）气道内有泡沫状液体。25例（89%）溺水受试者肺部有磨玻璃样实变并伴有间隔线，其中12例表现为轻度，呈尖部和肺门周围分布；9例表现为重度且弥漫性分布；3例表现为后部和基底部分布；1例局限于尖部（28例受试者中有3例因尸体腐败未评估）。对照组受试者有乳突气房积液（25%）、鼻窦积液（83%）、声门下气道积液（92%）以及肺部磨玻璃样实变（100%），但气道内无泡沫状液体或高密度沉积物的证据。
多排螺旋CT显示气道内有泡沫状液体或高密度气道沉积物高度提示溺水；在适当情况下，多排螺旋CT显示全鼻窦积液、乳突气房积液、声门下气管和支气管积液以及肺部磨玻璃样实变支持溺水诊断。
