At autopsy of a drowned body, which finding most reliably distinguishes VITAL drowning (ante-mortem) from post-mortem submersion?
- A Diatom analysis matching the drowning site in lung, liver and bone marrow ✓
- B Frothy fluid in the airways
- C Washerwoman's hands (maceration of skin)
- D Paltauf haemorrhages on the pleural surface
Correct answer: A. Diatom analysis matching the drowning site in lung, liver and bone marrow
Explanation
Diatom analysis is the gold standard for confirming vital drowning: diatoms from the water enter the bloodstream through the alveolar-capillary membrane only when the heart is still pumping, and are carried to protected internal organs (liver, kidney, bone marrow). Finding diatoms matching the drowning site in bone marrow (which is protected from post-mortem contamination) is the most reliable indicator of ante-mortem submersion. Frothy fluid, Paltauf haemorrhages, and maceration can occur in post-mortem submersion as well.
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.