At autopsy of a case of drowning, both lungs are markedly edematous and over-inflated, filling the thoracic cavity on opening the chest ("waterlogged lungs"). The stomach contains turbid water mixed with sand. Diatoms are found in the bone marrow. Which type of drowning does this BEST represent?

• A Wet drowning (freshwater) ✓
• B Dry drowning (10–15% of cases)
• C Secondary (delayed) drowning
• D Immersion syndrome

Explanation

Wet (typical) drowning accounts for 85–90% of cases and is characterised by active aspiration of water, producing waterlogged lungs, pulmonary oedema, and turbid stomach contents consistent with the drowning medium. Diatom penetration into bone marrow is diagnostic of ante-mortem drowning because passive post-mortem immersion does not generate sufficient intravascular pressure for haematogenous diatom distribution. Dry drowning (laryngospasm without significant water aspiration) shows comparatively drier lungs. Immersion syndrome results from vagally-mediated cardiac arrest before significant aspiration.

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.