During autopsy of a drowning victim, which of the following is considered the MOST reliable internal finding to confirm ante-mortem drowning?

• A Frothy fluid in airways and lungs (Paltauf haemorrhages)
• B Cutis anserina (goose skin) on the limbs
• C Diatoms in bone marrow or liver matching those in the drowning medium ✓
• D Washerwoman's hands (maceration of palms and soles)

Explanation

The diatom test is the most reliable confirmatory test for ante-mortem drowning. Diatoms (siliceous algae) are inhaled during active drowning and pass through the alveolar membrane into the pulmonary circulation; they then disseminate to remote organs such as liver, kidney, spleen, and crucially bone marrow. Finding diatoms of the same species in bone marrow or liver as those present in the drowning medium proves ante-mortem aspiration and cannot be explained by post-mortem immersion alone. Frothy fluid and cutis anserina may occur post-mortem, and washerwoman's changes indicate only prolonged immersion.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.