A body is retrieved from water. Autopsy reveals marked cadaveric emphysema, mushroom froth at nostrils and mouth, waterlogged lungs (combined weight > 1,500 g), presence of diatoms in liver and bone marrow, and a stomach containing 300 mL of turbid water. The MOST reliable finding to confirm antemortem drowning (as opposed to postmortem immersion) is:
- A Waterlogged lungs > 1,500 g combined weight
- B Presence of diatoms in liver, bone marrow, or brain (matching water source diatoms) ✓
- C Mushroom froth at mouth and nostrils
- D Water in the stomach
Explanation
The most reliable indicator of antemortem drowning (versus postmortem immersion) is the Diatom Test: diatoms (unicellular silica-shelled algae) from the drowning medium must traverse an intact respiratory epithelium and enter the systemic circulation to reach organs such as the liver, kidney, brain, and especially bone marrow (protected from postmortem contamination). Finding diatoms matching the water source in the bone marrow or internal organs confirms the victim was alive and breathing during submersion. Waterlogged lungs (A), froth (C), and stomach water (D) can all occur with postmortem immersion due to passive flooding, and are therefore less specific indicators of antemortem drowning.
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.