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Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

  • Forensic Medicine
  • Published:
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Abstract

Objective

To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning.

Methods

Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis.

Results

The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (−14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly (p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases (p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %.

Conclusion

The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume.

Key points

• Sinus fluid density of saltwater drowning is significantly higher than freshwater drowning.

• Cut-off value was 37.77 HU based on the ROC analysis.

• The cut-off value translated to 91 % NPV for diagnosis of saltwater drowning.

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Abbreviations

CT:

Computed tomography

MDCT:

Multi-detector computed tomography

DICOM:

Digital imaging and communication in medicine

ROC:

Receiver operating characteristic

PPV:

Positive predictive value

NPV:

Negative predictive value

References

  1. Dolinak D, Matshes E, Lew E (eds) (2005) Forensic pathology principles and practice. Elsevier, Amsterdam

    Google Scholar 

  2. Tsokos M (ed) (2005) Forensic pathology reviews volume 3. Humana Press, New York

    Google Scholar 

  3. Saukko P, Knight B (eds) (2004) Knight’s forensic pathology, 3rd edn. Edward Arnold, London

    Google Scholar 

  4. Pollanen MS, Cheung C, Chiasson DA (1997) The diagnostic value of the diatom test for drowning, I. utility: a retrospective analysis of 771 cases of drowning in Ontario, Canada. J Forensic Sci 42:281–285

    CAS  PubMed  Google Scholar 

  5. An JL, Ishida Y, Kimura A, Kondo T (2010) Forensic application of intrarenal aquaporin-2 expression for differential diagnosis between freshwater and saltwater drowning. Int J Legal Med 124(2):99–104

    Article  PubMed  Google Scholar 

  6. An JL, Ishida Y, Kimura A, Kondo T (2011) Immunohistochemical examination of intracerebral aquaporin-4 expression and its application for differential diagnosis between freshwater and saltwater drowning. Int J Legal Med 125(1):59–65

    Article  PubMed  Google Scholar 

  7. Cala AD, Vilain R, Tse R (2013) Elevated postmortem vitreous sodium and chloride levels distinguish saltwater drowning (SWD) deaths from immersion deaths not related to drowning but recovered from saltwater (DNRD). Am J Forensic Med Pathol 34(2):133–138

    Article  PubMed  Google Scholar 

  8. Thali MJ, Braun M, Buck U et al (2005) VIRTOPSY-scientific documentation, reconstruction and animation in forensic: individual and real 3D data based geo-metric approach including optical body/object surface and radiological CT/MRI scanning. J Forensic Sci 50:428–442

    Article  PubMed  Google Scholar 

  9. Dirnhofer R, Fackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26:1305–1333

    Article  PubMed  Google Scholar 

  10. Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P (2008) Virtual autopsy using imaging: bridging radiologic and forensic sciences. a review of the virtopsy and similar projects. Eur Radiol 18:273–282

    Article  PubMed  Google Scholar 

  11. Le Blanc-Louvry I, Thureau S, Duval C et al (2013) Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 23(7):1829–1835

    Article  PubMed  Google Scholar 

  12. Christe A, Aghayev E, Jackowski C, Thali MJ, Vock P (2008) Drowning—post-mortem imaging findings by computed tomography. Eur Radiol 18:283–290

    Article  PubMed  Google Scholar 

  13. Levy AD, Harcke HT, Getz JM et al (2007) Virtual autopsy: two- and three-dimensional multidetector CT findings in drowning with autopsy comparison. Radiology 243(3):862–868

    Article  PubMed  Google Scholar 

  14. Lo Re G, Vernuccio F, Galfano MC et al (2015) Role of virtopsy in the post-mortem diagnosis of drowning. Radiol Med 120(3):304–308

    Article  PubMed  Google Scholar 

  15. Ambrosetti MC, Barbiani C, El-Dalati G et al (2013) Virtual autopsy using multislice computed tomography in forensic medical diagnosis of drowning. Radiol Med 118:679–687

    Article  CAS  PubMed  Google Scholar 

  16. Kawasumi Y, Kawabata T, Sugai Y et al (2013) Diagnosis of drowning using post-mortem computed tomography based on the volume and density of fluid accumulation in the maxillary and sphenoid sinuses. Eur J Radiol 82(10):e562–e566

    Article  PubMed  Google Scholar 

  17. Byard RW, Cains G, Tsokos M (2006) Haemolytic staining of the intima of the aortic root-- a useful pathological marker of freshwater drowning? J Clin Forensic Med 13(3):125–128

    Article  PubMed  Google Scholar 

  18. Azparren JE, Cubero C, Perucha E, Martinez P, Vallejo G (2007) Comparison between lung weight and blood strontium in bodies found in seawater. Forensic Sci Int 168(2–3):128–132

    Article  CAS  PubMed  Google Scholar 

  19. Lucci A, Campobasso CP, Cirnelli A, Lorenzini G (2008) A promising microbiological test for the diagnosis of drowning. Forensic Sci Int 182(1–3):20–26

    Article  CAS  PubMed  Google Scholar 

  20. Maeda H, Zhu BL, Ishikawa T et al (2009) Analysis of postmortem biochemical findings with regard to the lung weight in drowning. Leg Med 11(Suppl 1):S269–S272

    Article  Google Scholar 

  21. Kawasumi Y, Kawabata T, Sugai Y et al (2012) Assessment of the relationship between drowning and fluid accumulation in the paranasal sinuses on post-mortem computed tomography. Eur J Radiol 81(12):3953–3955

    Article  PubMed  Google Scholar 

  22. Usumoto Y, Sameshima N, Hikiji W et al (2009) Electrolyte analysis of pleural effusion as an indicator of drowning in seawater and freshwater. J Forensic Leg Med 16:321–324

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Prof. Tadashi Ishibashi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: Retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Clinical Imaging, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Yusuke Kawasumi, Yuki Sato, Yumi Sato & Tadashi Ishibashi

  2. Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Akihito Usui, Nami Daigaku & Yoshiyuki Hosokai

  3. Department of Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Yoshie Hayashizaki & Masato Funayama

Authors
  1. Yusuke Kawasumi
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  2. Akihito Usui
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  3. Yuki Sato
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  4. Yumi Sato
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  5. Nami Daigaku
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  6. Yoshiyuki Hosokai
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  7. Yoshie Hayashizaki
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  8. Masato Funayama
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  9. Tadashi Ishibashi
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Correspondence to Yusuke Kawasumi.

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Kawasumi, Y., Usui, A., Sato, Y. et al. Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography. Eur Radiol 26, 1186–1190 (2016). https://doi.org/10.1007/s00330-015-3909-7

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  • DOI: https://doi.org/10.1007/s00330-015-3909-7

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