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PurposeTo investigate the effectiveness of postmortem computed tomography in the diagnosis of drowning, focusing on the comparison of fresh water and salt water cases using three-dimensionally (3D) reconstructed data.Materials and methodsWe examined features of drowning in 25 fresh water drowning cases (FWDCs; 13 men, 12 women; mean age 73.1 years; range 43–95 years), and compared these with 12 salt water drowning cases (SWDCs; 5 men, 7 women; mean age 66.0 years; range 55–77 years). Pulmonary opacities, volume and density (CT number) of accumulated fluid in the paranasal sinuses and central airways, volume of the stomach/stomach contents, and cardiac blood density were examined.ResultsIn SWDCs, pulmonary ground-glass opacities with wholly thickened interstitium was frequently identified (P = 0.0274). Whereas in FWDCs, a significantly larger volume and lower density of fluid in the paranasal sinuses (P = 0.0195 and P = 0.0104, respectively), lower density of fluid in the central airways (P = 0.0077), lower stomach content density (P = 0.0216), lower density in the left atrium (P = 0.0029), and a difference of density between the atria (P = 0.0247) were observed.ConclusionsA lower density in the left atrium was observed in FWDCs compared to SWDCs. This finding may be helpful in differentiating between FWDCs and SWDCs.

Whereas in FWDCs, a significantly larger volume and lower density of fluid in the paranasal sinuses (P = 0.0195 and P = 0.0104, respectively), lower density of fluid in the central airways (P = 0.0077), lower stomach content density (P = 0.0216), lower density in the left atrium (P = 0.0029), and a difference of density between the atria (P = 0.0019) were observed.