A 4-year-old girl was rescued from a swimming pool, coughed for a few minutes, appeared normal, and was sent home. Thirty-six hours later she returned with progressive breathlessness and died despite intensive care. Autopsy shows heavy, stiff lungs with diffuse alveolar damage. This death is best classified as:

• A Dry drowning
• B Secondary (delayed) drowning ✓
• C Immersion syndrome
• D Near-drowning without fatal outcome

Explanation

Secondary or delayed drowning refers to death hours to days after apparent recovery from a drowning episode, caused by aspirated water damaging the alveolar-capillary membrane and producing non-cardiogenic pulmonary oedema, surfactant washout and acute respiratory distress syndrome. Dry drowning means death from laryngospasm without water entry, and immersion syndrome is instant vagal cardiac arrest on entering cold water, neither of which fits survival followed by delayed respiratory failure. The autopsy picture of diffuse alveolar damage confirms the delayed aspiration mechanism.

Reference: Knight's Forensic Pathology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.